42D2303535 CLIA NUMBER - CAROLINA LAB 101

Laboratory Demographics

  • CLIA Code: 42D2303535
  • Facility Name: CAROLINA LAB 101
  • Facility Address: 3090 ROSEDALE DRIVE
    ORANGEBURG, SC
    ZIP 29115
  • Facility Phone: 803 490-4169
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: LAMIRA T. BENNETT
  • NPI Number: 1013750165
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 42D2303535
LAB Type Mobile Laboratory
Facility Name CAROLINA LAB 101
Street 3090 ROSEDALE DRIVE
City ORANGEBURG
State SC
ZIP 29115
Phone 803 490-4169
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Mobile Laboratory
Lab Director LAMIRA T. BENNETT

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