11D0254153 CLIA NUMBER - WELLSTAR COBB FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 11D0254153
  • Facility Name: WELLSTAR COBB FAMILY MEDICINE
  • Facility Address: 1790 MULKEY RD SW STE 8-A
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 944-1830
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: THOMAS GEARHARD
  • NPI Number: 1346294923
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0254153
LAB Type Physician Office
Facility Name WELLSTAR COBB FAMILY MEDICINE
Street 1790 MULKEY RD SW STE 8-A
City AUSTELL
State GA
ZIP 30106
Phone 770 944-1830
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 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director THOMAS GEARHARD

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