11D0967015 CLIA NUMBER - WELLSTAR PEDIATRICS AT BROOKSTONE

Laboratory Demographics

  • CLIA Code: 11D0967015
  • Facility Name: WELLSTAR PEDIATRICS AT BROOKSTONE
  • Facility Address: 5150 STILESBORO ROAD SUITE 220
    KENNESAW, GA
    ZIP 30152
  • Facility Phone: (770) 424-8222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SAUDIQA HOOSSAINY
  • NPI Number: 1255637211
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D0967015
LAB Type Physician Office
Facility Name WELLSTAR PEDIATRICS AT BROOKSTONE
Street 5150 STILESBORO ROAD SUITE 220
City KENNESAW
State GA
ZIP 30152
Phone 7704248222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2025
Certificate Expiration Date 11/29/2027
Facility Type Physician Office
Lab Director DR. SAUDIQA HOOSSAINY

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