42D2119172 CLIA NUMBER - PRISMA HEALTH ADVANCED FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 42D2119172
  • Facility Name: PRISMA HEALTH ADVANCED FAMILY MEDICINE
  • Facility Address: 210 S BROAD STREET
    CLINTON, SC
    ZIP 29325
  • Facility Phone: 864 833-0973
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL ODOM
  • NPI Number: 1134512395
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2119172
LAB Type Physician Office
Facility Name PRISMA HEALTH ADVANCED FAMILY MEDICINE
Street 210 S BROAD STREET
City CLINTON
State SC
ZIP 29325
Phone 864 833-0973
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Physician Office
Lab Director MICHAEL ODOM

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