11D2226422 CLIA NUMBER - PEDIATRIC CONVENIENT CARE

Laboratory Demographics

  • CLIA Code: 11D2226422
  • Facility Name: PEDIATRIC CONVENIENT CARE
  • Facility Address: 1114 GA HWY 96, SUITE D3 - D5
    KATHLEEN, GA
    ZIP 31047
  • Facility Phone: 478 910-1090
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: BRIDGET MOSLEY
  • NPI Number: 1023463510
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2226422
LAB Type Federally Qualified Health Center
Facility Name PEDIATRIC CONVENIENT CARE
Street 1114 GA HWY 96, SUITE D3 - D5
City KATHLEEN
State GA
ZIP 31047
Phone 478 910-1090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2025
Certificate Expiration Date 5/31/2027
Facility Type Federally Qualified Health Center
Lab Director BRIDGET MOSLEY

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