34D2138713 CLIA NUMBER - ATRIUM HEALTH WAKE FOREST BAPTIST CLINIC AT TOWN OF KERNERSVILLE

Laboratory Demographics

  • CLIA Code: 34D2138713
  • Facility Name: ATRIUM HEALTH WAKE FOREST BAPTIST CLINIC AT TOWN OF KERNERSVILLE
  • Facility Address: 316 WEST BODENHAMER STREET
    KERNERSVILLE, NC
    ZIP 27284
  • Facility Phone: 336 705-9573
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: STEVEN J. HAGEN
  • NPI Number: 1487879177
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 34D2138713
LAB Type Practitioner Other
Facility Name ATRIUM HEALTH WAKE FOREST BAPTIST CLINIC AT TOWN OF KERNERSVILLE
Street 316 WEST BODENHAMER STREET
City KERNERSVILLE
State NC
ZIP 27284
Phone 336 705-9573
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2023
Certificate Expiration Date 10/23/2025
Facility Type Practitioner Other
Lab Director STEVEN J. HAGEN

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