11D0256651 CLIA NUMBER - WELLSTAR NORTH COBB PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D0256651
  • Facility Name: WELLSTAR NORTH COBB PEDIATRICS
  • Facility Address: 205 HAWKINS STORE ROAD
    KENNESAW, GA
    ZIP 30144
  • Facility Phone: 770 928-0862
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NADINE H. THOMAS
  • NPI Number: 1932405073
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0256651
LAB Type Physician Office
Facility Name WELLSTAR NORTH COBB PEDIATRICS
Street 205 HAWKINS STORE ROAD
City KENNESAW
State GA
ZIP 30144
Phone 770 928-0862
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Physician Office
Lab Director NADINE H. THOMAS

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