11D0884136 CLIA NUMBER - WELLSTAR PEDIATRIC ADOLESCENT CENTER - AUSTELL

Laboratory Demographics

CLIA Number: 11D0884136

Facility Name: WELLSTAR PEDIATRIC ADOLESCENT CENTER - AUSTELL

Facility Address:
1810 MULKEY ROAD SUITE 201
AUSTELL, GA
ZIP 30106
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Facility Phone Number: 770 819-9262

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073819124

Taxonomy: 208000000X - Pediatrics
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

CLIA Record

Field Name	Field Value
CLIA Number	11D0884136
LAB Type	Physician Office
Facility Name	WELLSTAR PEDIATRIC ADOLESCENT CENTER - AUSTELL
Street	1810 MULKEY ROAD SUITE 201
City	AUSTELL
State	GA
ZIP	30106
Phone	770 819-9262
CertificateType	4
CertificateEffectiveDate	2/13/2023
CertificateExpirationDate	2/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024