11D2276167 CLIA NUMBER - HOMETOWN PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 11D2276167
  • Facility Name: HOMETOWN PEDIATRICS LLC
  • Facility Address: 108 N 4TH STREET
    VIENNA, GA
    ZIP 31092
  • Facility Phone: 229 231-5008
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HALEY E. PULLEN
  • NPI Number: 1013623263
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2276167
LAB Type Physician Office
Facility Name HOMETOWN PEDIATRICS LLC
Street 108 N 4TH STREET
City VIENNA
State GA
ZIP 31092
Phone 229 231-5008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Physician Office
Lab Director HALEY E. PULLEN

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