44D2090884 CLIA NUMBER - SOUTHERN CARDIOVASCULAR

Laboratory Demographics

  • CLIA Code: 44D2090884
  • Facility Name: SOUTHERN CARDIOVASCULAR
  • Facility Address: 6401 POPLAR AVE, SUITE 410
    MEMPHIS, TN
    ZIP 38119
  • Facility Phone: 901 259-2718
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN ELLICHMAN
  • NPI Number: 1033646658
  • Taxonomy: 385H00000X - Respite Care

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CLIA Record

Field Name Field Value
CLIA Number 44D2090884
LAB Type Physician Office
Facility Name SOUTHERN CARDIOVASCULAR
Street 6401 POPLAR AVE, SUITE 410
City MEMPHIS
State TN
ZIP 38119
Phone 901 259-2718
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2025
Certificate Expiration Date 2/1/2027
Facility Type Physician Office
Lab Director JONATHAN ELLICHMAN

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