11D2178572 CLIA NUMBER - MINDSET HEALTHCARE

Laboratory Demographics

  • CLIA Code: 11D2178572
  • Facility Name: MINDSET HEALTHCARE
  • Facility Address: 135 BRADFORD SQUARE SUITE B
    FAYETTEVILLE, GA
    ZIP 30215
  • Facility Phone: 470 646-3138
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OMOLOLA A. OTUBAGA
  • NPI Number: 1285119925
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2178572
LAB Type Physician Office
Facility Name MINDSET HEALTHCARE
Street 135 BRADFORD SQUARE SUITE B
City FAYETTEVILLE
State GA
ZIP 30215
Phone 470 646-3138
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2024
Certificate Expiration Date 2/4/2026
Facility Type Physician Office
Lab Director OMOLOLA A. OTUBAGA

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