11D1065297 CLIA NUMBER - EAGLES LANDING LONGEVITY CENTER

Laboratory Demographics

  • CLIA Code: 11D1065297
  • Facility Name: EAGLES LANDING LONGEVITY CENTER
  • Facility Address: 1325 ROCK QUARRY ROAD SUITE 100
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 389-0734
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GAYLA D. SYLVAIN MD
  • NPI Number: 1134524788
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1065297
LAB Type Physician Office
Facility Name EAGLES LANDING LONGEVITY CENTER
Street 1325 ROCK QUARRY ROAD SUITE 100
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 389-0734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2025
Certificate Expiration Date 2/26/2027
Facility Type Physician Office
Lab Director GAYLA D. SYLVAIN MD

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