34D2285665 CLIA NUMBER - PROACTIVE MD - BRAKEBUSH MOCKSVILLE

Laboratory Demographics

  • CLIA Code: 34D2285665
  • Facility Name: PROACTIVE MD - BRAKEBUSH MOCKSVILLE
  • Facility Address: 251 EATON RD
    MOCKSVILLE, NC
    ZIP 27028
  • Facility Phone: 828 548-0848
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: NICOLAS DALTON JOYNER
  • NPI Number: 1154036713
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 34D2285665
LAB Type Practitioner Other
Facility Name PROACTIVE MD - BRAKEBUSH MOCKSVILLE
Street 251 EATON RD
City MOCKSVILLE
State NC
ZIP 27028
Phone 828 548-0848
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Practitioner Other
Lab Director NICOLAS DALTON JOYNER

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