45D2043422 CLIA NUMBER - FAIRWAY PEDIATRICS, PLLC

Laboratory Demographics

  • CLIA Code: 45D2043422
  • Facility Name: FAIRWAY PEDIATRICS, PLLC
  • Facility Address: 4100 FAIRWAY DRIVE, SUITE 300
    CARROLLTON, TX
    ZIP 75010
  • Facility Phone: 469 855-2073
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JIAN WANG
  • NPI Number: 1821340472
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2043422
LAB Type Physician Office
Facility Name FAIRWAY PEDIATRICS, PLLC
Street 4100 FAIRWAY DRIVE, SUITE 300
City CARROLLTON
State TX
ZIP 75010
Phone 469 855-2073
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2024
Certificate Expiration Date 7/1/2026
Facility Type Physician Office
Lab Director JIAN WANG

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