11D0691952 CLIA NUMBER - WELLSTAR SMYRNA PRIMARY CARE CENTER

Laboratory Demographics

  • CLIA Code: 11D0691952
  • Facility Name: WELLSTAR SMYRNA PRIMARY CARE CENTER
  • Facility Address: 562 CONCORD ROAD, SE
    SMYRNA, GA
    ZIP 30082
  • Facility Phone: 770 384-9900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KYRA HARVEY
  • NPI Number: 1700182375
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0691952
LAB Type Physician Office
Facility Name WELLSTAR SMYRNA PRIMARY CARE CENTER
Street 562 CONCORD ROAD, SE
City SMYRNA
State GA
ZIP 30082
Phone 770 384-9900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2024
Certificate Expiration Date 8/15/2026
Facility Type Physician Office
Lab Director KYRA HARVEY

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