34D1100790 CLIA NUMBER - GREENBRIAR PRIMARY CARE PA

Laboratory Demographics

CLIA Number: 34D1100790

Facility Name: GREENBRIAR PRIMARY CARE PA

Facility Address:
308-C MCKSVILLE HWY
STATESVILLE, NC
ZIP 28625
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Facility Phone Number: 704 873-4484

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1477789147

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	34D1100790
LAB Type	Practitioner Other
Facility Name	GREENBRIAR PRIMARY CARE PA
Street	308-C MCKSVILLE HWY
City	STATESVILLE
State	NC
ZIP	28625
Phone	704 873-4484
CertificateType	4
CertificateEffectiveDate	6/12/2023
CertificateExpirationDate	6/11/2025
FacilityType	Waiver

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