34D2141661 CLIA NUMBER - LIVE WELL PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 34D2141661
  • Facility Name: LIVE WELL PRIMARY CARE, PLLC
  • Facility Address: 4822 SIX FORKS ROAD, SUITE 104
    RALEIGH, NC
    ZIP 27609
  • Facility Phone: 919 618-5772
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAGTANYA Y. BETTS
  • NPI Number: 1952811267
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2141661
LAB Type Physician Office
Facility Name LIVE WELL PRIMARY CARE, PLLC
Street 4822 SIX FORKS ROAD, SUITE 104
City RALEIGH
State NC
ZIP 27609
Phone 919 618-5772
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Physician Office
Lab Director DAGTANYA Y. BETTS

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