11D0997387 CLIA NUMBER - WELLSTAR FAMILY MED STILESBORO

Laboratory Demographics

  • CLIA Code: 11D0997387
  • Facility Name: WELLSTAR FAMILY MED STILESBORO
  • Facility Address: 5150 STILESBORO ROAD NW, SUITE 120
    KENNESAW, GA
    ZIP 30152
  • Facility Phone: 678 354-0230
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DWAYNE LUKE TERRY
  • NPI Number: 1558664003
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D0997387
LAB Type Physician Office
Facility Name WELLSTAR FAMILY MED STILESBORO
Street 5150 STILESBORO ROAD NW, SUITE 120
City KENNESAW
State GA
ZIP 30152
Phone 678 354-0230
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2024
Certificate Expiration Date 3/13/2026
Facility Type Physician Office
Lab Director DWAYNE LUKE TERRY

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