44D2305465 CLIA NUMBER - DETOX WEST TENNESSEE

Laboratory Demographics

  • CLIA Code: 44D2305465
  • Facility Name: DETOX WEST TENNESSEE
  • Facility Address: 370 NORTH CUMBERLAND ST
    JACKSON, TN
    ZIP 38301
  • Facility Phone: 731 736-2613
  • Facility Type: Other - SUD DETOX
  • Facility Type: Waiver
  • Lab Director: RONALD E. PRUITT
  • NPI Number: 1720694193
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 44D2305465
LAB Type Other - SUD DETOX
Facility Name DETOX WEST TENNESSEE
Street 370 NORTH CUMBERLAND ST
City JACKSON
State TN
ZIP 38301
Phone 731 736-2613
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2024
Certificate Expiration Date 5/30/2026
Facility Type Other - SUD DETOX
Lab Director RONALD E. PRUITT

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