01D0303723 CLIA NUMBER - LAKESIDE CLINIC LLC

Laboratory Demographics

  • Code: 01D0303723
  • Facility Name: LAKESIDE CLINIC LLC
  • Facility Address: 2337 HOMER CLAYTON DRIVE
    GUNTERSVILLE, AL
    ZIP 35976
  • Facility Phone: 256 582-5131
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • NPI Number: 1477657823
  • Taxonomy: 207Q00000X - Family Medicine
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CLIA Record

Field Name Field Value
CLIA Number 01D0303723
LAB Type Physician Office
Facility Name LAKESIDE CLINIC LLC
Street 2337 HOMER CLAYTON DRIVE
City GUNTERSVILLE
State AL
ZIP 35976
Phone 256 582-5131
Certificate Type 4
Certificate Effective Date 3/30/2023
Certificate Expiration Date 3/29/2025
Facility Type Waiver

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This page was last updated on: 4/23/2024