11D0964687 CLIA NUMBER - WELLSTAR KENMAR PEDIACTRICS - AHP

Laboratory Demographics

  • CLIA Code: 11D0964687
  • Facility Name: WELLSTAR KENMAR PEDIACTRICS - AHP
  • Facility Address: 4550 COBB PARKWAY, NORTH, NW, SUITE 302
    ACWORTH, GA
    ZIP 30101
  • Facility Phone: 770 427-0183
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTIAN WILLIAMS
  • NPI Number: 1346296746
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0964687
LAB Type Physician Office
Facility Name WELLSTAR KENMAR PEDIACTRICS - AHP
Street 4550 COBB PARKWAY, NORTH, NW, SUITE 302
City ACWORTH
State GA
ZIP 30101
Phone 770 427-0183
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2024
Certificate Expiration Date 2/1/2026
Facility Type Physician Office
Lab Director CHRISTIAN WILLIAMS

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