44D1043904 CLIA NUMBER - MICHIE HEALTHCARE ASSOCIATES LLC ATTN MARY LOCKHART

Laboratory Demographics

CLIA Number: 44D1043904

Facility Name: MICHIE HEALTHCARE ASSOCIATES LLC ATTN MARY LOCKHART

Facility Address:
5823 HIGHWAY 22 SOUTH
MICHIE, TN
ZIP 38357
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Facility Phone Number: 731 239-9470

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1841339777

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	44D1043904
LAB Type	Practitioner Other
Facility Name	MICHIE HEALTHCARE ASSOCIATES LLC ATTN MARY LOCKHART
Street	5823 HIGHWAY 22 SOUTH
City	MICHIE
State	TN
ZIP	38357
Phone	731 239-9470
CertificateType	4
CertificateEffectiveDate	8/5/2023
CertificateExpirationDate	8/4/2025
FacilityType	Waiver

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