44D2172788 CLIA NUMBER - PRESTIGE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 44D2172788
  • Facility Name: PRESTIGE FAMILY MEDICINE
  • Facility Address: 1409 W MARKET STREET SUITE 108
    JOHNSON CITY, TN
    ZIP 37604
  • Facility Phone: 423 833-0033
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DEBRA UNCAPHER
  • NPI Number: 1730755083
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D2172788
LAB Type Practitioner Other
Facility Name PRESTIGE FAMILY MEDICINE
Street 1409 W MARKET STREET SUITE 108
City JOHNSON CITY
State TN
ZIP 37604
Phone 423 833-0033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2025
Certificate Expiration Date 9/29/2027
Facility Type Practitioner Other
Lab Director DEBRA UNCAPHER

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