42D0901249 CLIA NUMBER - CAROLINA MEDICAL ASSOCIATES

Laboratory Demographics

  • CLIA Code: 42D0901249
  • Facility Name: CAROLINA MEDICAL ASSOCIATES
  • Facility Address: 1787 ALLENDALE FAIRFAX HWY
    FAIRFAX, SC
    ZIP 29827
  • Facility Phone: 803 632-3421
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. BRIAN PORT
  • NPI Number: 1144370503
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D0901249
LAB Type Physician Office
Facility Name CAROLINA MEDICAL ASSOCIATES
Street 1787 ALLENDALE FAIRFAX HWY
City FAIRFAX
State SC
ZIP 29827
Phone 803 632-3421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Physician Office
Lab Director DR. BRIAN PORT

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