11D2019890 CLIA NUMBER - WELLSTAR KENNESTONE IMAGING CTR AT TOWN LAKE

Laboratory Demographics

  • CLIA Code: 11D2019890
  • Facility Name: WELLSTAR KENNESTONE IMAGING CTR AT TOWN LAKE
  • Facility Address: 120 STONEBRDIGE PKWY, STE 300, ATTN KIM HARTLEY
    WOODSTOCK, GA
    ZIP 30189
  • Facility Phone: 678 494-2440
  • Facility Type: Other - MED IMAGING CTR
  • Facility Type: Waiver
  • Lab Director: STEVEN D. BRANTLEY
  • NPI Number: 1548216203
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 11D2019890
LAB Type Other - MED IMAGING CTR
Facility Name WELLSTAR KENNESTONE IMAGING CTR AT TOWN LAKE
Street 120 STONEBRDIGE PKWY, STE 300, ATTN KIM HARTLEY
City WOODSTOCK
State GA
ZIP 30189
Phone 678 494-2440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Other - MED IMAGING CTR
Lab Director STEVEN D. BRANTLEY

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