01D0707445 CLIA NUMBER - KEVIN L JACKSON MD

Laboratory Demographics

  • CLIA Code: 01D0707445
  • Facility Name: KEVIN L JACKSON MD
  • Facility Address: 2430 VILLAGE PROFESSIONAL DRIVE
    OPELIKA, AL
    ZIP 36801
  • Facility Phone: 334 821-6300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KEVIN L. JACKSON MD
  • NPI Number: 1316938517
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 01D0707445
LAB Type Physician Office
Facility Name KEVIN L JACKSON MD
Street 2430 VILLAGE PROFESSIONAL DRIVE
City OPELIKA
State AL
ZIP 36801
Phone 334 821-6300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. KEVIN L. JACKSON MD

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