01D0304172 CLIA NUMBER - JACKSON HOSPITAL & CLINIC

Laboratory Demographics

  • CLIA Code: 01D0304172
  • Facility Name: JACKSON HOSPITAL & CLINIC
  • Facility Address: 1722 PINE STREET SUITE 1002
    MONTGOMERY, AL
    ZIP 36106
  • Facility Phone: 334 293-8282
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM D. SMITH
  • NPI Number: 1336215748
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 01D0304172
LAB Type Physician Office
Facility Name JACKSON HOSPITAL & CLINIC
Street 1722 PINE STREET SUITE 1002
City MONTGOMERY
State AL
ZIP 36106
Phone 334 293-8282
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Physician Office
Lab Director WILLIAM D. SMITH

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