11D2172991 CLIA NUMBER - LIVE OAK WELLNESS, LLC

Laboratory Demographics

CLIA Code: 11D2172991
Facility Name: LIVE OAK WELLNESS, LLC
Facility Address: 1535 MOUNT VERNON ROAD
DUNWOODY, GA
ZIP 30338
Facility Phone: 770 238-2674
Facility Type: Tissue Bank/Repositories
Facility Type: Waiver
Lab Director: BENJAMIN HERRERA
NPI Number: 1730730839
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	11D2172991
LAB Type	Tissue Bank/Repositories
Facility Name	LIVE OAK WELLNESS, LLC
Street	1535 MOUNT VERNON ROAD
City	DUNWOODY
State	GA
ZIP	30338
Phone	770 238-2674
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/3/2025
Certificate Expiration Date	10/2/2027
Facility Type	Tissue Bank/Repositories
Lab Director	BENJAMIN HERRERA

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