11D2261980 CLIA NUMBER - DYNAMIC URGENT CARE PC

Laboratory Demographics

  • CLIA Code: 11D2261980
  • Facility Name: DYNAMIC URGENT CARE PC
  • Facility Address: 1600 KENNESAW DUE WEST ROAD, NW #205
    KENNESAW, GA
    ZIP 30152
  • Facility Phone: 470 632-4900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OLUMADE A. ADENUPE
  • NPI Number: 1053050021
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2261980
LAB Type Physician Office
Facility Name DYNAMIC URGENT CARE PC
Street 1600 KENNESAW DUE WEST ROAD, NW #205
City KENNESAW
State GA
ZIP 30152
Phone 470 632-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director OLUMADE A. ADENUPE

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