19D1024340 CLIA NUMBER - TILLERY FAMILY PRACITCE CLINIC

Laboratory Demographics

CLIA Number: 19D1024340

Facility Name: TILLERY FAMILY PRACITCE CLINIC

Facility Address:
3646 GENERAL DEGAULLE DR
NEW ORLEANS, LA
ZIP 70114
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Facility Phone Number: 504 365-9906

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1194870782

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D1024340
LAB Type	Physician Office
Facility Name	TILLERY FAMILY PRACITCE CLINIC
Street	3646 GENERAL DEGAULLE DR
City	NEW ORLEANS
State	LA
ZIP	70114
Phone	504 365-9906
CertificateType	4
CertificateEffectiveDate	8/6/2023
CertificateExpirationDate	8/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024