34D1012035 CLIA NUMBER - ATRIUM HEALTH PRIMARY CARE LAKE PARK FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 34D1012035
  • Facility Name: ATRIUM HEALTH PRIMARY CARE LAKE PARK FAMILY MEDICINE
  • Facility Address: 6066 HWY 74 WEST
    INDIAN TRAIL, NC
    ZIP 28079
  • Facility Phone: 704 882-1666
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS S. CHEN
  • NPI Number: 1487000659
  • Taxonomy: 343900000X - Non-emergency Medical Transport (VAN)

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CLIA Record

Field Name Field Value
CLIA Number 34D1012035
LAB Type Physician Office
Facility Name ATRIUM HEALTH PRIMARY CARE LAKE PARK FAMILY MEDICINE
Street 6066 HWY 74 WEST
City INDIAN TRAIL
State NC
ZIP 28079
Phone 704 882-1666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Physician Office
Lab Director DOUGLAS S. CHEN

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