49D1100236 CLIA NUMBER - WATOTO PEDIATRIC & ADOLESCENT SPEC LLC

Laboratory Demographics

  • CLIA Code: 49D1100236
  • Facility Name: WATOTO PEDIATRIC & ADOLESCENT SPEC LLC
  • Facility Address: 7915 LAKE MANASSAS DRIVE, SUITE 209
    GAINESVILLE, VA
    ZIP 20155
  • Facility Phone: (571) 248-0679
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IRVING C. WILLIAMS
  • NPI Number: 1457585481
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D1100236
LAB Type Physician Office
Facility Name WATOTO PEDIATRIC & ADOLESCENT SPEC LLC
Street 7915 LAKE MANASSAS DRIVE, SUITE 209
City GAINESVILLE
State VA
ZIP 20155
Phone 5712480679
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2025
Certificate Expiration Date 6/1/2027
Facility Type Physician Office
Lab Director IRVING C. WILLIAMS

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This page was last updated on: 5/18/2026