11D0862515 CLIA NUMBER - PRUITTHEALTH - LILBURN, LLC

Laboratory Demographics

  • CLIA Code: 11D0862515
  • Facility Name: PRUITTHEALTH - LILBURN, LLC
  • Facility Address: 788 INDIAN TRAIL ROAD
    LILBURN, GA
    ZIP 30047
  • Facility Phone: 770 923-2020
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: STACEY HENRY
  • NPI Number: 1043267560
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0862515
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRUITTHEALTH - LILBURN, LLC
Street 788 INDIAN TRAIL ROAD
City LILBURN
State GA
ZIP 30047
Phone 770 923-2020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director STACEY HENRY

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This page was last updated on: 6/4/2025