45D2007171 CLIA NUMBER - CHARLES E WILLIS II MD, PA

Laboratory Demographics

  • CLIA Code: 45D2007171
  • Facility Name: CHARLES E WILLIS II MD, PA
  • Facility Address: 911 YORK DR SUITE 205
    DESOTO, TX
    ZIP 75115
  • Facility Phone: 214 623-0550
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES E. WILLIS
  • NPI Number: 1114919412
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 45D2007171
LAB Type Physician Office
Facility Name CHARLES E WILLIS II MD, PA
Street 911 YORK DR SUITE 205
City DESOTO
State TX
ZIP 75115
Phone 214 623-0550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Physician Office
Lab Director CHARLES E. WILLIS

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