11D2308869 CLIA NUMBER - COOSA VALLEY WELLNESS, LLC

Laboratory Demographics

  • CLIA Code: 11D2308869
  • Facility Name: COOSA VALLEY WELLNESS, LLC
  • Facility Address: 4451 ALABAMA HIGHWAY, SUITE 2
    ROME, GA
    ZIP 30165
  • Facility Phone: 902 302-3202
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLIE CAMPBELL
  • NPI Number: 1003646902
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2308869
LAB Type Physician Office
Facility Name COOSA VALLEY WELLNESS, LLC
Street 4451 ALABAMA HIGHWAY, SUITE 2
City ROME
State GA
ZIP 30165
Phone 902 302-3202
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2024
Certificate Expiration Date 8/5/2026
Facility Type Physician Office
Lab Director CHARLIE CAMPBELL

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