42D0995075 CLIA NUMBER - ANGEL OAK FAMILY MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 42D0995075
  • Facility Name: ANGEL OAK FAMILY MEDICINE LLC
  • Facility Address: 1816 BOHICKET RD, SUITE F PO BOX 336
    JOHNS ISLAND, SC
    ZIP 29455
  • Facility Phone: 843 559-1938
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: JACQUELINE L. MENDES
  • NPI Number: 1548329097
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 42D0995075
LAB Type Community Clinic
Facility Name ANGEL OAK FAMILY MEDICINE LLC
Street 1816 BOHICKET RD, SUITE F PO BOX 336
City JOHNS ISLAND
State SC
ZIP 29455
Phone 843 559-1938
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Community Clinic
Lab Director JACQUELINE L. MENDES

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