44D2041170 CLIA NUMBER - CUMBERLAND GAP MEDICAL

Laboratory Demographics

  • CLIA Code: 44D2041170
  • Facility Name: CUMBERLAND GAP MEDICAL
  • Facility Address: 617 EAST CENTRAL AVENUE, STE 2
    LAFOLLETTE, TN
    ZIP 37766
  • Facility Phone: 423 201-9799
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AMANDA G. BROWN
  • NPI Number: 1336563204
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D2041170
LAB Type Practitioner Other
Facility Name CUMBERLAND GAP MEDICAL
Street 617 EAST CENTRAL AVENUE, STE 2
City LAFOLLETTE
State TN
ZIP 37766
Phone 423 201-9799
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Practitioner Other
Lab Director AMANDA G. BROWN

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