04D1036376 CLIA NUMBER - BRANDY DAVIS MD PA

Laboratory Demographics

  • CLIA Code: 04D1036376
  • Facility Name: BRANDY DAVIS MD PA
  • Facility Address: 904 HOLIDAY DRIVE SUITE 406
    FORREST CITY, AR
    ZIP 72335
  • Facility Phone: 870 494-4000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BRANDY A. DAVIS
  • NPI Number: 1629027313
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D1036376
LAB Type Physician Office
Facility Name BRANDY DAVIS MD PA
Street 904 HOLIDAY DRIVE SUITE 406
City FORREST CITY
State AR
ZIP 72335
Phone 870 494-4000
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/6/2025
Certificate Expiration Date 8/5/2027
Facility Type Physician Office
Lab Director BRANDY A. DAVIS

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