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KENNESTONE FAMILY MEDICINE
NPI 1891234118
Clinic/Center - Primary Care in Marietta, GA

Active since February 20, 2017CLIA 11D2039890 · Waiver
72 PLAZA WAY NW, MARIETTA, GA 30060(770) 795-8070 Get Directions Write a Review

NPPES record last updated: February 20, 2017. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Kennestone Family Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNESTONE FAMILY MEDICINE (NPI 1891234118) is a healthcare organization registered as a primary care in Marietta, Georgia and active in the NPI registry since February 2017. The organization holds a CLIA Waiver certificate valid through April 18, 2028 and lists Sam Peng, Md, as its authorized official.

NPPES Registry Identity

NPI1891234118
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameKENNESTONE FAMILY MEDICINE
Location Address72 PLAZA WAY NWMarietta, GA 30060-1104
Mailing Address72 Plaza Way NwMarietta, GA 30060-1104 · (770) 795-8070
Phone(770) 795-8070
Organization SubpartNo
Authorized OfficialSam PengMd · (770) 820-3855
Enumeration DateFebruary 20, 2017
✔ NPI 1891234118 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in GA · RN205404
72 PLAZA WAY NW, Marietta, GA 30060
Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2039890

Kennestone Family Medicine · Marietta, GA
Active · expires Apr 18, 2028
CLIA Number11D2039890
Laboratory TypePhysician Office
Certificate Effective DateApril 19, 2026
Certificate Expiration DateApril 18, 2028
Laboratory DirectorSam Q. Peng
Laboratory Phone(770) 795-8070
Laboratory LocationKennestone Family Medicine72 Plaza Way, Marietta, GA 30060
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MONICA E CLARK C.N.M.
Midwife
72 PLAZA WAY NW
MARIETTA, GA 30060
Cobb County (770) 422-8700
MICHELLE L DROMEY CNM
Advanced Practice Midwife
72 PLAZA WAY NW
MARIETTA, GA 30060
Cobb County (770) 422-8700
OB-GYN ASSOCIATES 2 LLC
Internal Medicine (Medical Oncology)
72 PLAZA WAY NW
MARIETTA, GA 30060
Cobb County (404) 943-0205
DR. LEE Q TIAN MD
Anesthesiology (Pain Medicine)
72 PLAZA WAY NW
MARIETTA, GA 30060
Cobb County (678) 813-2741
PEGGY A REGISTER C.N.M.
Midwife
72 PLAZA WAY NW
MARIETTA, GA 30060
Cobb County (770) 422-8700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kennestone Family Medicine's NPI number?

The NPI number for Kennestone Family Medicine is 1891234118. It was assigned to this organization in the NPPES registry on February 20, 2017.

Where is Kennestone Family Medicine located?

Kennestone Family Medicine is located at 72 Plaza Way NW, Marietta, GA 30060. The listed phone number is (770) 795-8070.

What is Kennestone Family Medicine's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Kennestone Family Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2039890) is associated with this NPI, valid through April 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kennestone Family Medicine was last updated on February 20, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.