19D2182938 CLIA NUMBER - DIVINITY HEALTH CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 19D2182938
  • Facility Name: DIVINITY HEALTH CLINIC, LLC
  • Facility Address: 4021 W E HECK CT, SUITE B-1
    BATON ROUGE, LA
    ZIP 70816
  • Facility Phone: 225 301-2982
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAWN MELANCON
  • NPI Number: 1326676792
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 19D2182938
LAB Type Physician Office
Facility Name DIVINITY HEALTH CLINIC, LLC
Street 4021 W E HECK CT, SUITE B-1
City BATON ROUGE
State LA
ZIP 70816
Phone 225 301-2982
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Physician Office
Lab Director DAWN MELANCON

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