42D2270953 CLIA NUMBER - PROACTIVE MD GREENVILLE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 42D2270953
  • Facility Name: PROACTIVE MD GREENVILLE HEALTH CENTER
  • Facility Address: 86 VILLA ROAD
    GREENVILLE, SC
    ZIP 29615
  • Facility Phone: 864 334-8919
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. DOUGLAS WHITEHEAD
  • NPI Number: 1184345159
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2270953
LAB Type Practitioner Other
Facility Name PROACTIVE MD GREENVILLE HEALTH CENTER
Street 86 VILLA ROAD
City GREENVILLE
State SC
ZIP 29615
Phone 864 334-8919
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Practitioner Other
Lab Director DR. DOUGLAS WHITEHEAD

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