21D2130720 CLIA NUMBER - WELLNESS SOURCE LLC

Laboratory Demographics

  • CLIA Code: 21D2130720
  • Facility Name: WELLNESS SOURCE LLC
  • Facility Address: 4301 GARDEN CITY DRIVE SUITE 304
    HYATTSVILLE, MD
    ZIP 20785
  • Facility Phone: (301) 235-0060
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARSHALEE GEORGE
  • NPI Number: 1114420320
  • Taxonomy: 133V00000X - Dietitian, Registered

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CLIA Record

Field Name Field Value
CLIA Number 21D2130720
LAB Type Practitioner Other
Facility Name WELLNESS SOURCE LLC
Street 4301 GARDEN CITY DRIVE SUITE 304
City HYATTSVILLE
State MD
ZIP 20785
Phone 3012350060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2025
Certificate Expiration Date 5/15/2027
Facility Type Practitioner Other
Lab Director MARSHALEE GEORGE

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