11D2149811 CLIA NUMBER - LOOKOUT MOUNTAIN COMMUNITY SERVICES AGENCY LAFAYETTE OUTPATIENT CLINIC

Laboratory Demographics

  • CLIA Code: 11D2149811
  • Facility Name: LOOKOUT MOUNTAIN COMMUNITY SERVICES AGENCY LAFAYETTE OUTPATIENT CLINIC
  • Facility Address: 501 MIZE STREET
    LAFAYETTE, GA
    ZIP 30728
  • Facility Phone: 706 638-5580
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: HEATHER ROESNER
  • NPI Number: 1942448444
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D2149811
LAB Type Community Clinic
Facility Name LOOKOUT MOUNTAIN COMMUNITY SERVICES AGENCY LAFAYETTE OUTPATIENT CLINIC
Street 501 MIZE STREET
City LAFAYETTE
State GA
ZIP 30728
Phone 706 638-5580
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Community Clinic
Lab Director HEATHER ROESNER

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