42D2111073 CLIA NUMBER - RIVERSIDE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 42D2111073
  • Facility Name: RIVERSIDE PEDIATRICS
  • Facility Address: 435 MARINA DRIVE
    GEORGETOWN, SC
    ZIP 29440
  • Facility Phone: 843 967-8139
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN P. ELIAS
  • NPI Number: 1275993420
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 42D2111073
LAB Type Physician Office
Facility Name RIVERSIDE PEDIATRICS
Street 435 MARINA DRIVE
City GEORGETOWN
State SC
ZIP 29440
Phone 843 967-8139
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Physician Office
Lab Director JONATHAN P. ELIAS

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