44D0313039 CLIA NUMBER - FARRAGUT FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 44D0313039
  • Facility Name: FARRAGUT FAMILY PRACTICE
  • Facility Address: 11130 KINGSTON PK, STE 7 & 8
    KNOXVILLE, TN
    ZIP 37934
  • Facility Phone: 865 675-1953
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RICHARD W. MATTISON
  • NPI Number: 1417120361
  • Taxonomy: 152WC0802X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 44D0313039
LAB Type Physician Office
Facility Name FARRAGUT FAMILY PRACTICE
Street 11130 KINGSTON PK, STE 7 & 8
City KNOXVILLE
State TN
ZIP 37934
Phone 865 675-1953
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Physician Office
Lab Director RICHARD W. MATTISON

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