04D0716907 CLIA NUMBER - BENNY J GREEN MD PA

Laboratory Demographics

  • CLIA Code: 04D0716907
  • Facility Name: BENNY J GREEN MD PA
  • Facility Address: 14309 CANTRELL ROAD SUITE 7
    LITTLE ROCK, AR
    ZIP 72223
  • Facility Phone: 501 224-6727
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: BENNY J. GREEN
  • NPI Number: 1609873983
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0716907
LAB Type Physician Office
Facility Name BENNY J GREEN MD PA
Street 14309 CANTRELL ROAD SUITE 7
City LITTLE ROCK
State AR
ZIP 72223
Phone 501 224-6727
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Physician Office
Lab Director BENNY J. GREEN

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