11D1082317 CLIA NUMBER - WELLSTAR CARDIOVASCULAR MEDICINE

Laboratory Demographics

CLIA Number: 11D1082317

Facility Name: WELLSTAR CARDIOVASCULAR MEDICINE

Facility Address:
120 STONEBRIDGE PARKWAY, SUITE 110
WOODSTOCK, GA
ZIP 30189
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Facility Phone Number: 678 324-4400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811272693

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	11D1082317
LAB Type	Physician Office
Facility Name	WELLSTAR CARDIOVASCULAR MEDICINE
Street	120 STONEBRIDGE PARKWAY, SUITE 110
City	WOODSTOCK
State	GA
ZIP	30189
Phone	678 324-4400
CertificateType	4
CertificateEffectiveDate	4/7/2024
CertificateExpirationDate	4/6/2026
FacilityType	Waiver

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