01D0683115 CLIA NUMBER - DR KEITH A DISMUKES

Laboratory Demographics

CLIA Number: 01D0683115

Facility Name: DR KEITH A DISMUKES

Facility Address:
202 HWY 80 EAST
DEMOPOLIS, AL
ZIP 36732
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Facility Phone Number: (334) 289-0499

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1801161138

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D0683115
LAB Type	PHYSICIAN OFFICE
Facility Name	DR KEITH A DISMUKES
Street	202 HWY 80 EAST
City	DEMOPOLIS
State	AL
ZIP	36732
Phone	(334) 289-0499

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This page was last updated on: 5/11/2023