11D2274360 CLIA NUMBER - PEDIATRIC CONVENIENT CARE

Laboratory Demographics

  • CLIA Code: 11D2274360
  • Facility Name: PEDIATRIC CONVENIENT CARE
  • Facility Address: 1205 US HIGHWAY 19 SOUTH
    LEESBURG, GA
    ZIP 31763
  • Facility Phone: 229 759-7028
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: BRIDGET MOSLEY
  • NPI Number: 1528556990
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2274360
LAB Type Federally Qualified Health Center
Facility Name PEDIATRIC CONVENIENT CARE
Street 1205 US HIGHWAY 19 SOUTH
City LEESBURG
State GA
ZIP 31763
Phone 229 759-7028
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Federally Qualified Health Center
Lab Director BRIDGET MOSLEY

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