11D2080638 CLIA NUMBER - WELLSTAR PEDIATRIC AFTER HOURS

Laboratory Demographics

  • CLIA Code: 11D2080638
  • Facility Name: WELLSTAR PEDIATRIC AFTER HOURS
  • Facility Address: 1180 ERNEST W BARRETT PARKWAY, NW, SUITE 102B
    KENNESAW, GA
    ZIP 30144
  • Facility Phone: 678 354-2273
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NICOLE DAVIDSON
  • NPI Number: 1457771925
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2080638
LAB Type Physician Office
Facility Name WELLSTAR PEDIATRIC AFTER HOURS
Street 1180 ERNEST W BARRETT PARKWAY, NW, SUITE 102B
City KENNESAW
State GA
ZIP 30144
Phone 678 354-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Physician Office
Lab Director NICOLE DAVIDSON

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