11D2072634 CLIA NUMBER - WELLSTAR MEDICAL GROUP FAMILY MED- WYLIE BRIDGE

Laboratory Demographics

  • CLIA Code: 11D2072634
  • Facility Name: WELLSTAR MEDICAL GROUP FAMILY MED- WYLIE BRIDGE
  • Facility Address: 14205 HIGHWAY 92, STE 101
    WOODSTOCK, GA
    ZIP 30188
  • Facility Phone: 678 293-7854
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STACEY OBRIEN
  • NPI Number: 1760893457
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2072634
LAB Type Physician Office
Facility Name WELLSTAR MEDICAL GROUP FAMILY MED- WYLIE BRIDGE
Street 14205 HIGHWAY 92, STE 101
City WOODSTOCK
State GA
ZIP 30188
Phone 678 293-7854
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2024
Certificate Expiration Date 2/3/2026
Facility Type Physician Office
Lab Director STACEY OBRIEN

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