01D1102832 CLIA NUMBER - JACKSON SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 01D1102832
  • Facility Name: JACKSON SURGERY CENTER LLC
  • Facility Address: 1725 PARK PLACE
    MONTGOMERY, AL
    ZIP 36106
  • Facility Phone: 334 293-8484
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. GILBERT CLINTON
  • NPI Number: 1336375930
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D1102832
LAB Type Ambulatory Surgery Center
Facility Name JACKSON SURGERY CENTER LLC
Street 1725 PARK PLACE
City MONTGOMERY
State AL
ZIP 36106
Phone 334 293-8484
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2025
Certificate Expiration Date 7/23/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. GILBERT CLINTON

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