42D2298461 CLIA NUMBER - ANGEL OAK PEDIATRICS

Laboratory Demographics

  • CLIA Code: 42D2298461
  • Facility Name: ANGEL OAK PEDIATRICS
  • Facility Address: 3312 MAYBANK HWY STE B
    JOHNS ISLAND, SC
    ZIP 29455
  • Facility Phone: 843 894-3490
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELLI E. JOHNSTON
  • NPI Number: 1265207229
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 42D2298461
LAB Type Physician Office
Facility Name ANGEL OAK PEDIATRICS
Street 3312 MAYBANK HWY STE B
City JOHNS ISLAND
State SC
ZIP 29455
Phone 843 894-3490
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2024
Certificate Expiration Date 2/1/2026
Facility Type Physician Office
Lab Director KELLI E. JOHNSTON

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