34D1034528 CLIA NUMBER - OWEN PARK PEDIATRICS PA

Laboratory Demographics

  • CLIA Code: 34D1034528
  • Facility Name: OWEN PARK PEDIATRICS PA
  • Facility Address: 1520 OWEN PARK LANE
    FAYETTEVILLE, NC
    ZIP 28304
  • Facility Phone: 910 860-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAUL O. ADHOLLA MD
  • NPI Number: 1548424104
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 34D1034528
LAB Type Physician Office
Facility Name OWEN PARK PEDIATRICS PA
Street 1520 OWEN PARK LANE
City FAYETTEVILLE
State NC
ZIP 28304
Phone 910 860-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2024
Certificate Expiration Date 12/5/2026
Facility Type Physician Office
Lab Director PAUL O. ADHOLLA MD

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