44D2085219 CLIA NUMBER - KAFUL (DOUBLE PORTION) FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 44D2085219
  • Facility Name: KAFUL (DOUBLE PORTION) FAMILY PRACTICE
  • Facility Address: 3740 OCOEE PLACE NW, SUITE 101
    CLEVELAND, TN
    ZIP 37312
  • Facility Phone: (423) 339-7107
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TIANDRA LOVE
  • NPI Number: 1386049476
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D2085219
LAB Type Practitioner Other
Facility Name KAFUL (DOUBLE PORTION) FAMILY PRACTICE
Street 3740 OCOEE PLACE NW, SUITE 101
City CLEVELAND
State TN
ZIP 37312
Phone 4233397107
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2024
Certificate Expiration Date 10/8/2026
Facility Type Practitioner Other
Lab Director TIANDRA LOVE

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This page was last updated on: 5/18/2026