42D0251071 CLIA NUMBER - TIDELANDS HEALTH FAMILY MEDICINE AT GEORGETOWN

Laboratory Demographics

  • CLIA Code: 42D0251071
  • Facility Name: TIDELANDS HEALTH FAMILY MEDICINE AT GEORGETOWN
  • Facility Address: 1075 N FRASER ST
    GEORGETOWN, SC
    ZIP 29440
  • Facility Phone: 843 527-4442
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. LUIS THORMER CHASTAIN
  • NPI Number: 1710464771
  • Taxonomy: 376J00000X - Homemaker

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CLIA Record

Field Name Field Value
CLIA Number 42D0251071
LAB Type Physician Office
Facility Name TIDELANDS HEALTH FAMILY MEDICINE AT GEORGETOWN
Street 1075 N FRASER ST
City GEORGETOWN
State SC
ZIP 29440
Phone 843 527-4442
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director DR. LUIS THORMER CHASTAIN

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