34D2295378 CLIA NUMBER - OUR TOWN PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 34D2295378
  • Facility Name: OUR TOWN PRIMARY CARE, PLLC
  • Facility Address: 463 SECOND ST
    AYDEN, NC
    ZIP 28513
  • Facility Phone: 252 651-5628
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BRANDY N. GALLOWAY
  • NPI Number: 1639857923
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 34D2295378
LAB Type Practitioner Other
Facility Name OUR TOWN PRIMARY CARE, PLLC
Street 463 SECOND ST
City AYDEN
State NC
ZIP 28513
Phone 252 651-5628
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2023
Certificate Expiration Date 12/10/2025
Facility Type Practitioner Other
Lab Director BRANDY N. GALLOWAY

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