42D2104778 CLIA NUMBER - PALMETTO ADULT AND CHILDRENS UROLOGY

Laboratory Demographics

  • CLIA Code: 42D2104778
  • Facility Name: PALMETTO ADULT AND CHILDRENS UROLOGY
  • Facility Address: 104 C MORGAN PLACE
    SUMMERVILLE, SC
    ZIP 29485
  • Facility Phone: (843) 797-7660
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THEODORE E. BRISSON
  • NPI Number: 1467440644
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 42D2104778
LAB Type Physician Office
Facility Name PALMETTO ADULT AND CHILDRENS UROLOGY
Street 104 C MORGAN PLACE
City SUMMERVILLE
State SC
ZIP 29485
Phone 8437977660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2025
Certificate Expiration Date 11/11/2027
Facility Type Physician Office
Lab Director THEODORE E. BRISSON

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This page was last updated on: 5/18/2026