11D2052152 CLIA NUMBER - STAR FAMILY HEALTHCARE AND WELLNESS CENTER

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Laboratory Demographics

CLIA Number: 11D2052152

Facility Name: STAR FAMILY HEALTHCARE AND WELLNESS CENTER

Facility Address:
5337 OLD NATIONAL HIGHWAY, SUITE 100
COLLEGE PARK, GA
ZIP 30349
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Facility Phone Number: 404 767-7777

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346590221

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	11D2052152
LAB Type	Physician Office
Facility Name	STAR FAMILY HEALTHCARE AND WELLNESS CENTER
Street	5337 OLD NATIONAL HIGHWAY, SUITE 100
City	COLLEGE PARK
State	GA
ZIP	30349
Phone	404 767-7777
CertificateType	4
CertificateEffectiveDate	1/7/2023
CertificateExpirationDate	1/6/2025
FacilityType	Waiver

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