44D2300930 CLIA NUMBER - GOODE PROVIDER LLC

Laboratory Demographics

  • CLIA Code: 44D2300930
  • Facility Name: GOODE PROVIDER LLC
  • Facility Address: 2969 MOUNTAIN TERRACE
    MEMPHIS, TN
    ZIP 38127
  • Facility Phone: 901 821-1123
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: COURTNEY GOODE
  • NPI Number: 1225527989
  • Taxonomy: 363LA2200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D2300930
LAB Type Practitioner Other
Facility Name GOODE PROVIDER LLC
Street 2969 MOUNTAIN TERRACE
City MEMPHIS
State TN
ZIP 38127
Phone 901 821-1123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2024
Certificate Expiration Date 3/18/2026
Facility Type Practitioner Other
Lab Director COURTNEY GOODE

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