44D0997950 CLIA NUMBER - COFFEE CO JAIL/MEDICAL

Laboratory Demographics

  • CLIA Code: 44D0997950
  • Facility Name: COFFEE CO JAIL/MEDICAL
  • Facility Address: 300 HILLSBORO BLVD
    MANCHESTER, TN
    ZIP 37355
  • Facility Phone: 931 728-3020
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. JOHNNY BATES
  • NPI Number: 1437164878
  • Taxonomy: 207P00000X - Emergency Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D0997950
LAB Type Rural Health Clinic
Facility Name COFFEE CO JAIL/MEDICAL
Street 300 HILLSBORO BLVD
City MANCHESTER
State TN
ZIP 37355
Phone 931 728-3020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Rural Health Clinic
Lab Director DR. JOHNNY BATES

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