34D0248520 CLIA NUMBER - PEACHTREE PEDIATRIC PLLC

Laboratory Demographics

CLIA Number: 34D0248520

Facility Name: PEACHTREE PEDIATRIC PLLC

Facility Address:
125 MEDICAL PARK LANE SUIE H
MURPHY, NC
ZIP 28906
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Facility Phone Number: 704 837-2128

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1255504924

Taxonomy: 207YX0905X - Otolaryngology
An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.

CLIA Record

Field Name	Field Value
CLIA Number	34D0248520
LAB Type	Physician Office
Facility Name	PEACHTREE PEDIATRIC PLLC
Street	125 MEDICAL PARK LANE SUIE H
City	MURPHY
State	NC
ZIP	28906
Phone	704 837-2128
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024