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11D2041541 CLIA NUMBER - WELLSTAR COMMUNITY TRANSQUILITY AT KENNESAW MTN

Laboratory Demographics

CLIA Number: 11D2041541

Facility Name: WELLSTAR COMMUNITY TRANSQUILITY AT KENNESAW MTN

Facility Address:
475 DICKSON AVENUE
MARIETTA, GA
ZIP 30064
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Facility Phone Number: 678 581-8380

Facility Type: Hospice

Certificate Type: Waiver
NPI Number: 1396791679

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 11D2041541
LAB Type Hospice
Facility Name WELLSTAR COMMUNITY TRANSQUILITY AT KENNESAW MTN
Street 475 DICKSON AVENUE
City MARIETTA
State GA
ZIP 30064
Phone 678 581-8380
CertificateType 4
CertificateEffectiveDate 5/24/2022
CertificateExpirationDate 5/23/2024
FacilityType Waiver

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