42D0673345 CLIA NUMBER - INTERNAL MEDICINE OF GREENWOOD A DIVISION OF SELF MED GRP

Laboratory Demographics

  • CLIA Code: 42D0673345
  • Facility Name: INTERNAL MEDICINE OF GREENWOOD A DIVISION OF SELF MED GRP
  • Facility Address: 115 OVERLAND DRIVE
    GREENWOOD, SC
    ZIP 29646
  • Facility Phone: 864 227-6641
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KIMBERLY RUSSELL
  • NPI Number: 1407146715
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D0673345
LAB Type Physician Office
Facility Name INTERNAL MEDICINE OF GREENWOOD A DIVISION OF SELF MED GRP
Street 115 OVERLAND DRIVE
City GREENWOOD
State SC
ZIP 29646
Phone 864 227-6641
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Physician Office
Lab Director DR. KIMBERLY RUSSELL

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