34D0695267 CLIA NUMBER - MOUNT OLIVE FAMILY MEDICINE CENTER, INC

Laboratory Demographics

  • CLIA Code: 34D0695267
  • Facility Name: MOUNT OLIVE FAMILY MEDICINE CENTER, INC
  • Facility Address: 201 NORTH BREAZEALE AVENUE
    MOUNT OLIVE, NC
    ZIP 28365
  • Facility Phone: 919 658-4954
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MR. THOMAS SCOTT DRAUGHON
  • NPI Number: 1841328390
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 34D0695267
LAB Type Physician Office
Facility Name MOUNT OLIVE FAMILY MEDICINE CENTER, INC
Street 201 NORTH BREAZEALE AVENUE
City MOUNT OLIVE
State NC
ZIP 28365
Phone 919 658-4954
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Physician Office
Lab Director MR. THOMAS SCOTT DRAUGHON

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