44D2297804 CLIA NUMBER - LAKE MED, PLLC

Laboratory Demographics

  • CLIA Code: 44D2297804
  • Facility Name: LAKE MED, PLLC
  • Facility Address: 906 DINAH SHORE BLVD, SUITE 102
    WINCHESTER, TN
    ZIP 37398
  • Facility Phone: 931 998-2915
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMY L. RICHARDSON
  • NPI Number: 1356111728
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D2297804
LAB Type Physician Office
Facility Name LAKE MED, PLLC
Street 906 DINAH SHORE BLVD, SUITE 102
City WINCHESTER
State TN
ZIP 37398
Phone 931 998-2915
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Physician Office
Lab Director AMY L. RICHARDSON

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