01D2283404 CLIA NUMBER - BY HIS GRACE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 01D2283404
  • Facility Name: BY HIS GRACE PRIMARY CARE
  • Facility Address: 806 GLOVER AVE, SUITE A
    ENTERPRISE, AL
    ZIP 36330
  • Facility Phone: 334 475-2680
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAMANTHA PICKETT
  • NPI Number: 1073202115
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 01D2283404
LAB Type Physician Office
Facility Name BY HIS GRACE PRIMARY CARE
Street 806 GLOVER AVE, SUITE A
City ENTERPRISE
State AL
ZIP 36330
Phone 334 475-2680
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/7/2025
Certificate Expiration Date 6/6/2027
Facility Type Physician Office
Lab Director SAMANTHA PICKETT

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