11D2204425 CLIA NUMBER - OUR VILLAGE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D2204425
  • Facility Name: OUR VILLAGE PEDIATRICS
  • Facility Address: 115 ACADEMY STREET SUITE 101
    CANTON, GA
    ZIP 30114
  • Facility Phone: 470 389-4970
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHANIE HASSEL MCNEIL
  • NPI Number: 1255952347
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2204425
LAB Type Physician Office
Facility Name OUR VILLAGE PEDIATRICS
Street 115 ACADEMY STREET SUITE 101
City CANTON
State GA
ZIP 30114
Phone 470 389-4970
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2024
Certificate Expiration Date 12/8/2026
Facility Type Physician Office
Lab Director STEPHANIE HASSEL MCNEIL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025