34D2172120 CLIA NUMBER - WAKEMED PRIMARY CARE -WAKE FOREST MEDICAL PARK

Laboratory Demographics

  • CLIA Code: 34D2172120
  • Facility Name: WAKEMED PRIMARY CARE -WAKE FOREST MEDICAL PARK
  • Facility Address: 1030 SIENA DRIVE, SUITE # 130
    WAKE FOREST, NC
    ZIP 27587
  • Facility Phone: 919 350-7180
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACQUELINE M. HICKS
  • NPI Number: 1225684004
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2172120
LAB Type Physician Office
Facility Name WAKEMED PRIMARY CARE -WAKE FOREST MEDICAL PARK
Street 1030 SIENA DRIVE, SUITE # 130
City WAKE FOREST
State NC
ZIP 27587
Phone 919 350-7180
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/31/2025
Certificate Expiration Date 1/30/2027
Facility Type Physician Office
Lab Director JACQUELINE M. HICKS

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