34D2122092 CLIA NUMBER - SIMPLECLINIC, PLLC

Laboratory Demographics

  • CLIA Code: 34D2122092
  • Facility Name: SIMPLECLINIC, PLLC
  • Facility Address: 1074 SOUTHERN AVENUE
    FAYETTEVILLE, NC
    ZIP 28306
  • Facility Phone: 910 491-4530
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: JONATHAN HANCOCK
  • NPI Number: 1255998944
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 34D2122092
LAB Type Practitioner Other
Facility Name SIMPLECLINIC, PLLC
Street 1074 SOUTHERN AVENUE
City FAYETTEVILLE
State NC
ZIP 28306
Phone 910 491-4530
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Practitioner Other
Lab Director JONATHAN HANCOCK

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