44D2132451 CLIA NUMBER - NORTHSIDE MEDICAL PROFESSIONALS PC

Laboratory Demographics

  • CLIA Code: 44D2132451
  • Facility Name: NORTHSIDE MEDICAL PROFESSIONALS PC
  • Facility Address: 1203 TROTWOOD AVE
    COLUMBIA, TN
    ZIP 38401
  • Facility Phone: 931 540-4210
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. SHAWN N. GENTRY
  • NPI Number: 1295044097
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D2132451
LAB Type Physician Office
Facility Name NORTHSIDE MEDICAL PROFESSIONALS PC
Street 1203 TROTWOOD AVE
City COLUMBIA
State TN
ZIP 38401
Phone 931 540-4210
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Physician Office
Lab Director DR. SHAWN N. GENTRY

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This page was last updated on: 6/4/2025