01D0304764 CLIA NUMBER - SOUTHEAST HEALTH FAIRVIEW CLINIC

Laboratory Demographics

  • CLIA Code: 01D0304764
  • Facility Name: SOUTHEAST HEALTH FAIRVIEW CLINIC
  • Facility Address: 1118 ROSS CLARK CIRCLE SUITE 303
    DOTHAN, AL
    ZIP 36301
  • Facility Phone: 334 618-5777
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: KALA M. BAKER
  • NPI Number: 1184693053
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 01D0304764
LAB Type Physician Office
Facility Name SOUTHEAST HEALTH FAIRVIEW CLINIC
Street 1118 ROSS CLARK CIRCLE SUITE 303
City DOTHAN
State AL
ZIP 36301
Phone 334 618-5777
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Physician Office
Lab Director KALA M. BAKER

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