01D2300200 CLIA NUMBER - ABC PEDIATRIC WEST

Laboratory Demographics

  • CLIA Code: 01D2300200
  • Facility Name: ABC PEDIATRIC WEST
  • Facility Address: 400 19TH ST E
    JASPER, AL
    ZIP 35501
  • Facility Phone: 205 936-8107
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. LEAH V. GANN
  • NPI Number: 1316714512
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 01D2300200
LAB Type Physician Office
Facility Name ABC PEDIATRIC WEST
Street 400 19TH ST E
City JASPER
State AL
ZIP 35501
Phone 205 936-8107
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Physician Office
Lab Director MS. LEAH V. GANN

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