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

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.

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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

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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