11D0878822 CLIA NUMBER - BRIDGE WELLNESS SOUTH CORPORATION, THE

Laboratory Demographics

  • CLIA Code: 11D0878822
  • Facility Name: BRIDGE WELLNESS SOUTH CORPORATION, THE
  • Facility Address: 100 EAGLES WALK
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 957-8288
  • Facility Type: Other - NON-PROFIT PREG RESOURCE
  • Facility Type: Waiver
  • Lab Director: REUBEAN A. REYNOLDS
  • NPI Number: 1265484182
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 11D0878822
LAB Type Other - NON-PROFIT PREG RESOURCE
Facility Name BRIDGE WELLNESS SOUTH CORPORATION, THE
Street 100 EAGLES WALK
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 957-8288
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Other - NON-PROFIT PREG RESOURCE
Lab Director REUBEAN A. REYNOLDS

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