34D2017674 CLIA NUMBER - CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY

Laboratory Demographics

  • CLIA Code: 34D2017674
  • Facility Name: CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY
  • Facility Address: 5501 FORTUNES RIDGE DRIVE
    DURHAM, NC
    ZIP 27713
  • Facility Phone: 919 419-9222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY S. JELIC
  • NPI Number: 1861642001
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 34D2017674
LAB Type Physician Office
Facility Name CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY
Street 5501 FORTUNES RIDGE DRIVE
City DURHAM
State NC
ZIP 27713
Phone 919 419-9222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Physician Office
Lab Director JEFFREY S. JELIC

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This page was last updated on: 3/20/2025