44D2022894 CLIA NUMBER - WELLNESS ONE MEMPHIS, PC

Laboratory Demographics

  • CLIA Code: 44D2022894
  • Facility Name: WELLNESS ONE MEMPHIS, PC
  • Facility Address: 6100 PRIMACY PKWY STE 112
    MEMPHIS, TN
    ZIP 38119
  • Facility Phone: 901 682-5335
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL D. RADICAN
  • NPI Number: 1124497730
  • Taxonomy: 207QS0010X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D2022894
LAB Type Physician Office
Facility Name WELLNESS ONE MEMPHIS, PC
Street 6100 PRIMACY PKWY STE 112
City MEMPHIS
State TN
ZIP 38119
Phone 901 682-5335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Physician Office
Lab Director RUSSELL D. RADICAN

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