44D2079983 CLIA NUMBER - RESTORATION CLINIC, PLLC

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Laboratory Demographics

CLIA Number: 44D2079983

Facility Name: RESTORATION CLINIC, PLLC

Facility Address:
17619 STATE HWY 58 N
DECATUR, TN
ZIP 37322
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Facility Phone Number: 423 334-2300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1205248796

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2079983
LAB Type	Physician Office
Facility Name	RESTORATION CLINIC, PLLC
Street	17619 STATE HWY 58 N
City	DECATUR
State	TN
ZIP	37322
Phone	423 334-2300
CertificateType	4
CertificateEffectiveDate	6/27/2022
CertificateExpirationDate	6/26/2024
FacilityType	Waiver

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