11D2050086 CLIA NUMBER - PIEDMONT URGENT CARE BY WELLSTREET-MT VERNON

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Laboratory Demographics

CLIA Number: 11D2050086

Facility Name: PIEDMONT URGENT CARE BY WELLSTREET-MT VERNON

Facility Address:
1575 MOUNT VERNON ROAD
DUNWOODY, GA
ZIP 30338
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Facility Phone Number: 770 809-3036

Facility Type: Other - URGENT CARE CENTER

Certificate Type: Waiver

NPI Number: 1720579188

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	11D2050086
LAB Type	Other - URGENT CARE CENTER
Facility Name	PIEDMONT URGENT CARE BY WELLSTREET-MT VERNON
Street	1575 MOUNT VERNON ROAD
City	DUNWOODY
State	GA
ZIP	30338
Phone	770 809-3036
CertificateType	4
CertificateEffectiveDate	11/20/2022
CertificateExpirationDate	11/19/2024
FacilityType	Waiver

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