44D0921240 CLIA NUMBER - GRACE FAMILY PRACTICE CLINIC, PC

Laboratory Demographics

  • CLIA Code: 44D0921240
  • Facility Name: GRACE FAMILY PRACTICE CLINIC, PC
  • Facility Address: 1716 PARR AVE STE D
    DYERSBURG, TN
    ZIP 38024
  • Facility Phone: 731 288-0911
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. MONIQUE C. CASEY-BOLDEN
  • NPI Number: 1083124671
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D0921240
LAB Type Physician Office
Facility Name GRACE FAMILY PRACTICE CLINIC, PC
Street 1716 PARR AVE STE D
City DYERSBURG
State TN
ZIP 38024
Phone 731 288-0911
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Physician Office
Lab Director DR. MONIQUE C. CASEY-BOLDEN

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