11D2274412 CLIA NUMBER - BROOKHAVEN LIFESTANCE HEALTH

Laboratory Demographics

  • CLIA Code: 11D2274412
  • Facility Name: BROOKHAVEN LIFESTANCE HEALTH
  • Facility Address: 2801 BUFORD HIGHWAY, NE, SUITE 100
    BROOKHAVEN, GA
    ZIP 30329
  • Facility Phone: 678 820-7830
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HELAINA JAFFE
  • NPI Number: 1508540196
  • Taxonomy: 261QD0000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2274412
LAB Type Physician Office
Facility Name BROOKHAVEN LIFESTANCE HEALTH
Street 2801 BUFORD HIGHWAY, NE, SUITE 100
City BROOKHAVEN
State GA
ZIP 30329
Phone 678 820-7830
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Physician Office
Lab Director HELAINA JAFFE

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This page was last updated on: 6/4/2025