11D2299511 CLIA NUMBER - PRUITTPLACE BUCKHEAD, LLC DBA PRUITTPLACE- BUCKHEAD

Laboratory Demographics

  • CLIA Code: 11D2299511
  • Facility Name: PRUITTPLACE BUCKHEAD, LLC DBA PRUITTPLACE- BUCKHEAD
  • Facility Address: 3088 LENOX ROAD NE
    ATLANTA, GA
    ZIP 30324
  • Facility Phone: 770 279-6200
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MARK RABEN
  • NPI Number: 1083476105
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2299511
LAB Type Assisted Living Facility
Facility Name PRUITTPLACE BUCKHEAD, LLC DBA PRUITTPLACE- BUCKHEAD
Street 3088 LENOX ROAD NE
City ATLANTA
State GA
ZIP 30324
Phone 770 279-6200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2024
Certificate Expiration Date 2/21/2026
Facility Type Assisted Living Facility
Lab Director MARK RABEN

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