34D2229593 CLIA NUMBER - VICTORY MEDICAL, PLLC

Laboratory Demographics

  • CLIA Code: 34D2229593
  • Facility Name: VICTORY MEDICAL, PLLC
  • Facility Address: 305 SOUTH MAIN ST
    BLADENBORO, NC
    ZIP 28320
  • Facility Phone: (910) 809-0082
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAPHNE R. GREEN
  • NPI Number: 1356917793
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 34D2229593
LAB Type Physician Office
Facility Name VICTORY MEDICAL, PLLC
Street 305 SOUTH MAIN ST
City BLADENBORO
State NC
ZIP 28320
Phone 9108090082
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Physician Office
Lab Director DAPHNE R. GREEN

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This page was last updated on: 6/29/2026