04D2229479 CLIA NUMBER - MARK S KING MD PA

Laboratory Demographics

  • CLIA Code: 04D2229479
  • Facility Name: MARK S KING MD PA
  • Facility Address: 2062 HWY 62 W
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 425-5464
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LONNIE M. HAMMONDS JR
  • NPI Number: 1891882072
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 04D2229479
LAB Type Physician Office
Facility Name MARK S KING MD PA
Street 2062 HWY 62 W
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 425-5464
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Physician Office
Lab Director DR. LONNIE M. HAMMONDS JR

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