01D0300393 CLIA NUMBER - COOSA VALLEY UROLOGY

Laboratory Demographics

  • CLIA Code: 01D0300393
  • Facility Name: COOSA VALLEY UROLOGY
  • Facility Address: 16 SOUTH DOUGLAS AVENUE
    SYLACAUGA, AL
    ZIP 35150
  • Facility Phone: 256 245-2269
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MAMOUN R. PACHA
  • NPI Number: 1083831804
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 01D0300393
LAB Type Physician Office
Facility Name COOSA VALLEY UROLOGY
Street 16 SOUTH DOUGLAS AVENUE
City SYLACAUGA
State AL
ZIP 35150
Phone 256 245-2269
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Physician Office
Lab Director MAMOUN R. PACHA

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