11D2304225 CLIA NUMBER - PEDIATRIC CENTER FOR WELLNESS

Laboratory Demographics

  • CLIA Code: 11D2304225
  • Facility Name: PEDIATRIC CENTER FOR WELLNESS
  • Facility Address: 1015 MILSTEAD AVENUE, SUITE 100
    CONYERS, GA
    ZIP 30012
  • Facility Phone: 678 750-4000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CRYSTAL HOOD
  • NPI Number: 1437416708
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2304225
LAB Type Physician Office
Facility Name PEDIATRIC CENTER FOR WELLNESS
Street 1015 MILSTEAD AVENUE, SUITE 100
City CONYERS
State GA
ZIP 30012
Phone 678 750-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2024
Certificate Expiration Date 5/8/2026
Facility Type Physician Office
Lab Director CRYSTAL HOOD

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