11D0705825 CLIA NUMBER - WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES

Laboratory Demographics

  • CLIA Code: 11D0705825
  • Facility Name: WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES
  • Facility Address: 121 MARBLE MILL ROAD SUITE 101
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 770 422-8315
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANUEL COUTINHO
  • NPI Number: 1083660682
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D0705825
LAB Type Physician Office
Facility Name WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES
Street 121 MARBLE MILL ROAD SUITE 101
City MARIETTA
State GA
ZIP 30060
Phone 770 422-8315
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Physician Office
Lab Director MANUEL COUTINHO

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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