11D2263477 CLIA NUMBER - THE SULTON PEDIATRIC GROUP, PC

Laboratory Demographics

  • CLIA Code: 11D2263477
  • Facility Name: THE SULTON PEDIATRIC GROUP, PC
  • Facility Address: 2258 NORTHLAKE PARKWAY, SUITE 100
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 670-6100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACQUELINE R. SULTON
  • NPI Number: 1003075003
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2263477
LAB Type Physician Office
Facility Name THE SULTON PEDIATRIC GROUP, PC
Street 2258 NORTHLAKE PARKWAY, SUITE 100
City TUCKER
State GA
ZIP 30084
Phone 770 670-6100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Physician Office
Lab Director JACQUELINE R. SULTON

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