42D2257730 CLIA NUMBER - AG SCREENING LAB, LLC

Laboratory Demographics

  • CLIA Code: 42D2257730
  • Facility Name: AG SCREENING LAB, LLC
  • Facility Address: 108A E MAIN STREET
    LATTA, SC
    ZIP 29565
  • Facility Phone: 843 616-8770
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: MS. LOMETRIA WILSON
  • NPI Number: 1528704830
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 42D2257730
LAB Type Independent
Facility Name AG SCREENING LAB, LLC
Street 108A E MAIN STREET
City LATTA
State SC
ZIP 29565
Phone 843 616-8770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Independent
Lab Director MS. LOMETRIA WILSON

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