01D1062614 CLIA NUMBER - WIREGRASS UROLOGY PC

Laboratory Demographics

  • CLIA Code: 01D1062614
  • Facility Name: WIREGRASS UROLOGY PC
  • Facility Address: 4300 W MAIN STREET SUITE 102
    DOTHAN, AL
    ZIP 36305
  • Facility Phone: 334 793-9564
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROGER JUDD WILLIAMS
  • NPI Number: 1992096440
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 01D1062614
LAB Type Physician Office
Facility Name WIREGRASS UROLOGY PC
Street 4300 W MAIN STREET SUITE 102
City DOTHAN
State AL
ZIP 36305
Phone 334 793-9564
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Physician Office
Lab Director ROGER JUDD WILLIAMS

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