42D2177402 CLIA NUMBER - PROACTIVE MD MAULDIN HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 42D2177402
  • Facility Name: PROACTIVE MD MAULDIN HEALTH CENTER
  • Facility Address: 787 B E BUTLER RD
    MAULDIN, SC
    ZIP 29662
  • Facility Phone: 864 501-0815
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. PHILIP ESKEW
  • NPI Number: 1548883960
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2177402
LAB Type Practitioner Other
Facility Name PROACTIVE MD MAULDIN HEALTH CENTER
Street 787 B E BUTLER RD
City MAULDIN
State SC
ZIP 29662
Phone 864 501-0815
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 Practitioner Other
Lab Director DR. PHILIP ESKEW

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