44D0965624 CLIA NUMBER - PEDIATRIC CHOICE CLINIC

Laboratory Demographics

CLIA Number: 44D0965624

Facility Name: PEDIATRIC CHOICE CLINIC

Facility Address:
136 MOUNTAIN PERKINS LANE, SUITE 2
JACKSBORO, TN
ZIP 37757
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Facility Phone Number: 865 986-1400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518112911

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	44D0965624
LAB Type	Physician Office
Facility Name	PEDIATRIC CHOICE CLINIC
Street	136 MOUNTAIN PERKINS LANE, SUITE 2
City	JACKSBORO
State	TN
ZIP	37757
Phone	865 986-1400
CertificateType	4
CertificateEffectiveDate	7/23/2022
CertificateExpirationDate	7/22/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024