11D1035559 CLIA NUMBER - PEBBLEBROOK HEALTH CENTER AT PARK SPRINGS

Laboratory Demographics

  • CLIA Code: 11D1035559
  • Facility Name: PEBBLEBROOK HEALTH CENTER AT PARK SPRINGS
  • Facility Address: 5610 NEW BERMUDA ROAD
    STONE MOUNTAIN, GA
    ZIP 30087
  • Facility Phone: 770 879-4330
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: WILLIAM MARK MCKETTRICK
  • NPI Number: 1184605693
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D1035559
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PEBBLEBROOK HEALTH CENTER AT PARK SPRINGS
Street 5610 NEW BERMUDA ROAD
City STONE MOUNTAIN
State GA
ZIP 30087
Phone 770 879-4330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2025
Certificate Expiration Date 1/4/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director WILLIAM MARK MCKETTRICK

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