42D2071186 CLIA NUMBER - POWDERSVILLE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 42D2071186
  • Facility Name: POWDERSVILLE PRIMARY CARE
  • Facility Address: 290 ENTERPRISE DRIVE
    EASLEY, SC
    ZIP 29640
  • Facility Phone: 864 365-0290
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: COLLIS BARKSDALE
  • NPI Number: 1578991741
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2071186
LAB Type Physician Office
Facility Name POWDERSVILLE PRIMARY CARE
Street 290 ENTERPRISE DRIVE
City EASLEY
State SC
ZIP 29640
Phone 864 365-0290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Physician Office
Lab Director COLLIS BARKSDALE

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