01D0303594 CLIA NUMBER - SAND MOUNTAIN FAMILY PRACTICE CENTER

Laboratory Demographics

  • CLIA Code: 01D0303594
  • Facility Name: SAND MOUNTAIN FAMILY PRACTICE CENTER
  • Facility Address: 5104 HWY 431
    ALBERTVILLE, AL
    ZIP 35950
  • Facility Phone: 256 878-8184
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROAN S. GANNON
  • NPI Number: 1952825523
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 01D0303594
LAB Type Physician Office
Facility Name SAND MOUNTAIN FAMILY PRACTICE CENTER
Street 5104 HWY 431
City ALBERTVILLE
State AL
ZIP 35950
Phone 256 878-8184
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Physician Office
Lab Director ROAN S. GANNON

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