01D2274046 CLIA NUMBER - GRACE INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 01D2274046
  • Facility Name: GRACE INTERNAL MEDICINE
  • Facility Address: 102 MEDICAL CENTER DRIVE
    PRATTVILLE, AL
    ZIP 36066
  • Facility Phone: 334 568-2335
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VANOSIA S. FAISON
  • NPI Number: 1740990886
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D2274046
LAB Type Physician Office
Facility Name GRACE INTERNAL MEDICINE
Street 102 MEDICAL CENTER DRIVE
City PRATTVILLE
State AL
ZIP 36066
Phone 334 568-2335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Physician Office
Lab Director VANOSIA S. FAISON

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