11D2303652 CLIA NUMBER - PONYA DIAGNOSTICS, LLC

Laboratory Demographics

  • CLIA Code: 11D2303652
  • Facility Name: PONYA DIAGNOSTICS, LLC
  • Facility Address: 13 CORPORATE BOULEVARD, NE, SUITE 100
    BROOKHAVEN, GA
    ZIP 30329
  • Facility Phone: 229 442-7210
  • Facility Type: Independent
  • Facility Type: Accreditation
  • Lab Director: BERNADETTE M. WILDEMORE
  • NPI Number: 1629964721
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2303652
LAB Type Independent
Facility Name PONYA DIAGNOSTICS, LLC
Street 13 CORPORATE BOULEVARD, NE, SUITE 100
City BROOKHAVEN
State GA
ZIP 30329
Phone 229 442-7210
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 4/29/2024
Certificate Expiration Date 4/28/2026
Facility Type Independent
Lab Director BERNADETTE M. WILDEMORE

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