11D2310997 CLIA NUMBER - GRACE PEDIATRICS AND WELLNESS

Laboratory Demographics

  • CLIA Code: 11D2310997
  • Facility Name: GRACE PEDIATRICS AND WELLNESS
  • Facility Address: 63 PLOTT STREET, SUITE A
    BLAIRSVILLE, GA
    ZIP 30512
  • Facility Phone: 706 745-2968
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JOSE D. MEJIA JR
  • NPI Number: 1811734676
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2310997
LAB Type Practitioner Other
Facility Name GRACE PEDIATRICS AND WELLNESS
Street 63 PLOTT STREET, SUITE A
City BLAIRSVILLE
State GA
ZIP 30512
Phone 706 745-2968
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Practitioner Other
Lab Director JOSE D. MEJIA JR

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