11D0254181 CLIA NUMBER - WELLSTAR OB/GYN AUSTELL

Laboratory Demographics

  • CLIA Code: 11D0254181
  • Facility Name: WELLSTAR OB/GYN AUSTELL
  • Facility Address: 1700 HOSPITAL SOUTH DR SUITE 500
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: (770) 941-7717
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUPRIYA RAO
  • NPI Number: 1578811782
  • Taxonomy: 208M00000X - Hospitalist

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CLIA Record

Field Name Field Value
CLIA Number 11D0254181
LAB Type Physician Office
Facility Name WELLSTAR OB/GYN AUSTELL
Street 1700 HOSPITAL SOUTH DR SUITE 500
City AUSTELL
State GA
ZIP 30106
Phone 7709417717
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director SUPRIYA RAO

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