44D1004412 CLIA NUMBER - FAYETTE COUNTY AMBULANCE SERVICE

Laboratory Demographics

  • CLIA Code: 44D1004412
  • Facility Name: FAYETTE COUNTY AMBULANCE SERVICE
  • Facility Address: 102 LATTA LANE
    SOMERVILLE, TN
    ZIP 38068
  • Facility Phone: 901 465-2755
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: SAMUEL C. MCKNIGHT
  • NPI Number: 1750621629
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 44D1004412
LAB Type Ambulance
Facility Name FAYETTE COUNTY AMBULANCE SERVICE
Street 102 LATTA LANE
City SOMERVILLE
State TN
ZIP 38068
Phone 901 465-2755
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Ambulance
Lab Director SAMUEL C. MCKNIGHT

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