11D2114987 CLIA NUMBER - WELLSTAR COMPREHENSIVE CARE AT KENNESTONE

Laboratory Demographics

CLIA Number: 11D2114987

Facility Name: WELLSTAR COMPREHENSIVE CARE AT KENNESTONE

Facility Address:
175 WHITE STREET, SUITE 100
MARIETTA, GA
ZIP 30060
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Facility Phone Number: 470 793-0225

Facility Type: Other - OUTPATIENT CLINIC

Certificate Type: Accreditation

NPI Number: 1205195724

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	11D2114987
LAB Type	Other - OUTPATIENT CLINIC
Facility Name	WELLSTAR COMPREHENSIVE CARE AT KENNESTONE
Street	175 WHITE STREET, SUITE 100
City	MARIETTA
State	GA
ZIP	30060
Phone	470 793-0225
CertificateType	1
CertificateEffectiveDate	1/18/2023
CertificateExpirationDate	1/17/2025
FacilityType	Accreditation

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