11D0256897 CLIA NUMBER - WELLSTAR TOWNE LAKE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 11D0256897
  • Facility Name: WELLSTAR TOWNE LAKE MEDICAL GROUP
  • Facility Address: 145 NORTH MEDICAL PKWY
    WOODSTOCK, GA
    ZIP 30189
  • Facility Phone: 770 592-3000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEERTHI MULAMALLA
  • NPI Number: 1548566185
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0256897
LAB Type Physician Office
Facility Name WELLSTAR TOWNE LAKE MEDICAL GROUP
Street 145 NORTH MEDICAL PKWY
City WOODSTOCK
State GA
ZIP 30189
Phone 770 592-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Physician Office
Lab Director KEERTHI MULAMALLA

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