11D2255911 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE - STONE MOUNTAIN

Laboratory Demographics

  • CLIA Code: 11D2255911
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE - STONE MOUNTAIN
  • Facility Address: 5244 MEMORIAL DRIVE SUITE #1101
    STONE MOUNTAIN, GA
    ZIP 30083
  • Facility Phone: (404) 905-0100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERICA SAVAGE-JETER
  • NPI Number: 1760059331
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2255911
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE - STONE MOUNTAIN
Street 5244 MEMORIAL DRIVE SUITE #1101
City STONE MOUNTAIN
State GA
ZIP 30083
Phone 4049050100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2026
Certificate Expiration Date 3/17/2028
Facility Type Physician Office
Lab Director ERICA SAVAGE-JETER

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This page was last updated on: 5/18/2026