11D2172437 CLIA NUMBER - WELLSTAR PEDIATRIC UROLOGY

Laboratory Demographics

  • CLIA Code: 11D2172437
  • Facility Name: WELLSTAR PEDIATRIC UROLOGY
  • Facility Address: 1180 ERNEST W BARRETT PARKWAY NW, SUITE 102A
    KENNESAW, GA
    ZIP 30144
  • Facility Phone: 470 956-1600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID RIDEN
  • NPI Number: 1174565311
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2172437
LAB Type Physician Office
Facility Name WELLSTAR PEDIATRIC UROLOGY
Street 1180 ERNEST W BARRETT PARKWAY NW, SUITE 102A
City KENNESAW
State GA
ZIP 30144
Phone 470 956-1600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Physician Office
Lab Director DAVID RIDEN

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