01D0662761 CLIA NUMBER - SHOALS PRIMARY CARE MEDICAL-MALL LOCATION

Laboratory Demographics

  • CLIA Code: 01D0662761
  • Facility Name: SHOALS PRIMARY CARE MEDICAL-MALL LOCATION
  • Facility Address: 1404 EAST AVALON AVENUE SUITE A
    TUSCUMBIA, AL
    ZIP 35674
  • Facility Phone: 256 381-6853
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JAVAR B. MYATT-JONES

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CLIA Record

Field Name Field Value
CLIA Number 01D0662761
LAB Type Physician Office
Facility Name SHOALS PRIMARY CARE MEDICAL-MALL LOCATION
Street 1404 EAST AVALON AVENUE SUITE A
City TUSCUMBIA
State AL
ZIP 35674
Phone 256 381-6853
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Physician Office
Lab Director DR. JAVAR B. MYATT-JONES

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This page was last updated on: 3/20/2025