11D0933113 CLIA NUMBER - WELLSTAR SHALLOWFORD MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 11D0933113
  • Facility Name: WELLSTAR SHALLOWFORD MEDICAL CENTER
  • Facility Address: 3921 SHALLOWFORD ROAD
    MARIETTA, GA
    ZIP 30062
  • Facility Phone: (770) 649-9100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REAZ M. SIDDIQUI
  • NPI Number: 1174829741
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D0933113
LAB Type Physician Office
Facility Name WELLSTAR SHALLOWFORD MEDICAL CENTER
Street 3921 SHALLOWFORD ROAD
City MARIETTA
State GA
ZIP 30062
Phone 7706499100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Physician Office
Lab Director REAZ M. SIDDIQUI

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This page was last updated on: 5/18/2026