42D2299214 CLIA NUMBER - PROACTIVE MD NORTH CHARLESTON

Laboratory Demographics

  • CLIA Code: 42D2299214
  • Facility Name: PROACTIVE MD NORTH CHARLESTON
  • Facility Address: 3520 W MONTAGUE AVE, SUITE 202
    NORTH CHARLESTON, SC
    ZIP 29418
  • Facility Phone: 843 580-8650
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: GRETA E. SNOW
  • NPI Number: 1811640667
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2299214
LAB Type Practitioner Other
Facility Name PROACTIVE MD NORTH CHARLESTON
Street 3520 W MONTAGUE AVE, SUITE 202
City NORTH CHARLESTON
State SC
ZIP 29418
Phone 843 580-8650
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2024
Certificate Expiration Date 2/14/2026
Facility Type Practitioner Other
Lab Director GRETA E. SNOW

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