34D2120159 CLIA NUMBER - PREMIUM WELLNESS AND PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 34D2120159
  • Facility Name: PREMIUM WELLNESS AND PRIMARY CARE
  • Facility Address: 308 POMONA DR STE A
    GREENSBORO, NC
    ZIP 27407
  • Facility Phone: 336 553-0793
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JOHN Z. HALL
  • NPI Number: 1336599547
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 34D2120159
LAB Type Practitioner Other
Facility Name PREMIUM WELLNESS AND PRIMARY CARE
Street 308 POMONA DR STE A
City GREENSBORO
State NC
ZIP 27407
Phone 336 553-0793
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type Practitioner Other
Lab Director JOHN Z. HALL

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