49D2265674 CLIA NUMBER - SOUTHSIDE SPECTRUM PEDIATRICS PLLC

Laboratory Demographics

  • CLIA Code: 49D2265674
  • Facility Name: SOUTHSIDE SPECTRUM PEDIATRICS PLLC
  • Facility Address: 5320 PROVIDENCE RD, SUITE 100
    VIRGINIA BEACH, VA
    ZIP 23464
  • Facility Phone: (757) 937-3029
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TAMBRA M. HOLLINGSWORTH
  • NPI Number: 1013661917
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D2265674
LAB Type Practitioner Other
Facility Name SOUTHSIDE SPECTRUM PEDIATRICS PLLC
Street 5320 PROVIDENCE RD, SUITE 100
City VIRGINIA BEACH
State VA
ZIP 23464
Phone 7579373029
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Practitioner Other
Lab Director TAMBRA M. HOLLINGSWORTH

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