01D2104581 CLIA NUMBER - TWILIGHT MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 01D2104581

Facility Name: TWILIGHT MEDICAL CLINIC

Facility Address:
22270 HWY 72 EAST SUITE A
ATHENS, AL
ZIP 35613
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Facility Phone Number: 256 998-5120

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518330414

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	01D2104581
LAB Type	Physician Office
Facility Name	TWILIGHT MEDICAL CLINIC
Street	22270 HWY 72 EAST SUITE A
City	ATHENS
State	AL
ZIP	35613
Phone	256 998-5120
CertificateType	4
CertificateEffectiveDate	11/9/2023
CertificateExpirationDate	11/8/2025
FacilityType	Waiver

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