01D0304710 CLIA NUMBER - DIANA M MANCUSO MD

Laboratory Demographics

  • Code: 01D0304710
  • Facility Name: DIANA M MANCUSO MD
  • Facility Address: 4300 W MAIN SUITE #16
    DOTHAN, AL
    ZIP 36305
  • Facility Phone: 334 793-4120
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • NPI Number: 1417971037
  • Taxonomy: 207Q00000X - Family Medicine
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CLIA Record

Field Name Field Value
CLIA Number 01D0304710
LAB Type Physician Office
Facility Name DIANA M MANCUSO MD
Street 4300 W MAIN SUITE #16
City DOTHAN
State AL
ZIP 36305
Phone 334 793-4120
Certificate Type 3
Certificate Effective Date 8/19/2022
Certificate Expiration Date 8/18/2024
Facility Type PPMP

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This page was last updated on: 4/23/2024