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11D1062906 CLIA NUMBER - WELLNESS PRIMARYCARE, LLC

Laboratory Demographics

CLIA Number: 11D1062906

Facility Name: WELLNESS PRIMARYCARE, LLC

Facility Address:
5456 JIMMY CARTER BOULEVARD, SUITE 240
NORCROSS, GA
ZIP 30093
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Facility Phone Number: 678 380-9889

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1124291927

Taxonomy: 171M00000X - Case Manager/Care Coordinator
A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.

CLIA Record

Field Name Field Value
CLIA Number 11D1062906
LAB Type Physician Office
Facility Name WELLNESS PRIMARYCARE, LLC
Street 5456 JIMMY CARTER BOULEVARD, SUITE 240
City NORCROSS
State GA
ZIP 30093
Phone 678 380-9889
CertificateType 3
CertificateEffectiveDate 12/29/2022
CertificateExpirationDate 12/28/2024
FacilityType PPMP

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This page was last updated on: 4/23/2024