01D2190669 CLIA NUMBER - MAIN STREET CLINIC LLC

Laboratory Demographics

  • CLIA Code: 01D2190669
  • Facility Name: MAIN STREET CLINIC LLC
  • Facility Address: 2850 DR JOHN HAYNES DRIVE
    PELL CITY, AL
    ZIP 35125
  • Facility Phone: 256 418-4300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MUHAMMAD E. ATA
  • NPI Number: 1740895291
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 01D2190669
LAB Type Physician Office
Facility Name MAIN STREET CLINIC LLC
Street 2850 DR JOHN HAYNES DRIVE
City PELL CITY
State AL
ZIP 35125
Phone 256 418-4300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2024
Certificate Expiration Date 8/17/2026
Facility Type Physician Office
Lab Director MUHAMMAD E. ATA

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