44D2080428 CLIA NUMBER - PREFERRED FAMILY MEDICAL CARE, LLC

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Laboratory Demographics

CLIA Number: 44D2080428

Facility Name: PREFERRED FAMILY MEDICAL CARE, LLC

Facility Address:
9026 HIWASSEE ST NE
CHARLESTON, TN
ZIP 37310
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Facility Phone Number: 423 665-9026

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699188029

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2080428
LAB Type	Physician Office
Facility Name	PREFERRED FAMILY MEDICAL CARE, LLC
Street	9026 HIWASSEE ST NE
City	CHARLESTON
State	TN
ZIP	37310
Phone	423 665-9026
CertificateType	4
CertificateEffectiveDate	7/8/2022
CertificateExpirationDate	7/7/2024
FacilityType	Waiver

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