44D2018813 CLIA NUMBER - CYNTHIA L WALLACE, MD

Laboratory Demographics

  • CLIA Code: 44D2018813
  • Facility Name: CYNTHIA L WALLACE, MD
  • Facility Address: 4779 ANDREW JACKSON PKWY STE 201
    HERMITAGE, TN
    ZIP 37076
  • Facility Phone: 615 889-7010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CYNTHIA L. WALLACE
  • NPI Number: 1386615540
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D2018813
LAB Type Physician Office
Facility Name CYNTHIA L WALLACE, MD
Street 4779 ANDREW JACKSON PKWY STE 201
City HERMITAGE
State TN
ZIP 37076
Phone 615 889-7010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2025
Certificate Expiration Date 1/13/2027
Facility Type Physician Office
Lab Director DR. CYNTHIA L. WALLACE

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