01D2177092 CLIA NUMBER - SAFE HARBOR OF THE SHOALS, INC

Laboratory Demographics

CLIA Number: 01D2177092

Facility Name: SAFE HARBOR OF THE SHOALS, INC

Facility Address:
1404 E AVALON AVENUE SUITE C
TUSCUMBIA, AL
ZIP 35674
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Facility Phone Number: 256 381-5507

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831743483

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name	Field Value
CLIA Number	01D2177092
LAB Type	Physician Office
Facility Name	SAFE HARBOR OF THE SHOALS, INC
Street	1404 E AVALON AVENUE SUITE C
City	TUSCUMBIA
State	AL
ZIP	35674
Phone	256 381-5507
CertificateType	4
CertificateEffectiveDate	1/3/2024
CertificateExpirationDate	1/2/2026
FacilityType	Waiver

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