11D2071354 CLIA NUMBER - WELLSTAR FAMILY MEDICINE AT VININGS JUBILEE

Laboratory Demographics

  • CLIA Code: 11D2071354
  • Facility Name: WELLSTAR FAMILY MEDICINE AT VININGS JUBILEE
  • Facility Address: 2850 PACES FERRY ROAD, SE, SUITE 460
    ATLANTA, GA
    ZIP 30339
  • Facility Phone: (678) 556-4950
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KRYSTINA A. ROWE
  • NPI Number: 1710319462
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2071354
LAB Type Physician Office
Facility Name WELLSTAR FAMILY MEDICINE AT VININGS JUBILEE
Street 2850 PACES FERRY ROAD, SE, SUITE 460
City ATLANTA
State GA
ZIP 30339
Phone 6785564950
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2026
Certificate Expiration Date 5/31/2028
Facility Type Physician Office
Lab Director KRYSTINA A. ROWE

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This page was last updated on: 5/18/2026