44D2186319 CLIA NUMBER - REVIVE KETAMINE CLINIC, PLLC

Laboratory Demographics

  • CLIA Code: 44D2186319
  • Facility Name: REVIVE KETAMINE CLINIC, PLLC
  • Facility Address: 6220 GREENLEE STREET SUITE 2
    ARLINGTON, TN
    ZIP 38002
  • Facility Phone: 901 317-7900
  • Facility Type: Other - INFUSION CLINIC
  • Facility Type: Waiver
  • Lab Director: GINGER M. WILLIAMS
  • NPI Number: 1053984484
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D2186319
LAB Type Other - INFUSION CLINIC
Facility Name REVIVE KETAMINE CLINIC, PLLC
Street 6220 GREENLEE STREET SUITE 2
City ARLINGTON
State TN
ZIP 38002
Phone 901 317-7900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Other - INFUSION CLINIC
Lab Director GINGER M. WILLIAMS

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