11D2145565 CLIA NUMBER - EVERGREEN PRIMARY CARE AND WELLNESS, PC

Laboratory Demographics

  • CLIA Code: 11D2145565
  • Facility Name: EVERGREEN PRIMARY CARE AND WELLNESS, PC
  • Facility Address: 2450 ATLANTA HWY, SUITE 803
    CUMMING, GA
    ZIP 30040
  • Facility Phone: 470 253-7944
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HEATHER B. WANNER
  • NPI Number: 1285134999
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2145565
LAB Type Physician Office
Facility Name EVERGREEN PRIMARY CARE AND WELLNESS, PC
Street 2450 ATLANTA HWY, SUITE 803
City CUMMING
State GA
ZIP 30040
Phone 470 253-7944
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Physician Office
Lab Director HEATHER B. WANNER

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