11D0254112 CLIA NUMBER - WELLSTAR COBB GYNECOLOGIST

Laboratory Demographics

  • CLIA Code: 11D0254112
  • Facility Name: WELLSTAR COBB GYNECOLOGIST
  • Facility Address: 1791 MULKEY RD STE 200
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 732-5400
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Microscopy
  • Lab Director: STEVEN LEE
  • NPI Number: 1013330364
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0254112
LAB Type Ancillary Testing Site in Health Care Center
Facility Name WELLSTAR COBB GYNECOLOGIST
Street 1791 MULKEY RD STE 200
City AUSTELL
State GA
ZIP 30106
Phone 770 732-5400
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Ancillary Testing Site in Health Care Center
Lab Director STEVEN LEE

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