44D2186186 CLIA NUMBER - CRESTHAVEN INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 44D2186186
  • Facility Name: CRESTHAVEN INTERNAL MEDICINE
  • Facility Address: 6799 GREAT OAKS ROAD SUITE 105
    MEMPHIS, TN
    ZIP 38138
  • Facility Phone: 901 821-8300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JEREMY S. AVILA
  • NPI Number: 1164489175
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D2186186
LAB Type Physician Office
Facility Name CRESTHAVEN INTERNAL MEDICINE
Street 6799 GREAT OAKS ROAD SUITE 105
City MEMPHIS
State TN
ZIP 38138
Phone 901 821-8300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2024
Certificate Expiration Date 6/14/2026
Facility Type Physician Office
Lab Director DR. JEREMY S. AVILA

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