04D2200397 CLIA NUMBER - PREMIERE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 04D2200397
  • Facility Name: PREMIERE FAMILY PRACTICE
  • Facility Address: 1904 GRANT AVE SUITE G
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 901 921-2686
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MR. ELHAM A. ARMAH
  • NPI Number: 1932708641
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2200397
LAB Type Practitioner Other
Facility Name PREMIERE FAMILY PRACTICE
Street 1904 GRANT AVE SUITE G
City JONESBORO
State AR
ZIP 72401
Phone 901 921-2686
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Practitioner Other
Lab Director MR. ELHAM A. ARMAH

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