42D0977791 CLIA NUMBER - PALMETTO PRIMARY CARE PHYSICIANS MONCKS CORNER

Laboratory Demographics

  • CLIA Code: 42D0977791
  • Facility Name: PALMETTO PRIMARY CARE PHYSICIANS MONCKS CORNER
  • Facility Address: 115 EXECUTIVE PARKWAY
    MONCKS CORNER, SC
    ZIP 29461
  • Facility Phone: 843 761-2815
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: EDWARD J. JONES MD
  • NPI Number: 1104866623
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D0977791
LAB Type Physician Office
Facility Name PALMETTO PRIMARY CARE PHYSICIANS MONCKS CORNER
Street 115 EXECUTIVE PARKWAY
City MONCKS CORNER
State SC
ZIP 29461
Phone 843 761-2815
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 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Physician Office
Lab Director EDWARD J. JONES MD

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