11D2293011 CLIA NUMBER - WELLTOUCH WELLNESS CLINIC LLC

Laboratory Demographics

CLIA Number: 11D2293011

Facility Name: WELLTOUCH WELLNESS CLINIC LLC

Facility Address:
252 SHANNON WAY
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 404 409-9439

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1780466532

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	11D2293011
LAB Type	Practitioner Other
Facility Name	WELLTOUCH WELLNESS CLINIC LLC
Street	252 SHANNON WAY
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	404 409-9439
CertificateType	4
CertificateEffectiveDate	11/2/2023
CertificateExpirationDate	11/1/2025
FacilityType	Waiver

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