01D2324954 CLIA NUMBER - OLIVE BRANCH DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 01D2324954
  • Facility Name: OLIVE BRANCH DERMATOLOGY
  • Facility Address: 4721 CHACE CIR
    HOOVER, AL
    ZIP 35244
  • Facility Phone: 205 266-9011
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMENA ALKESWANI
  • NPI Number: 1750197794
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 01D2324954
LAB Type Physician Office
Facility Name OLIVE BRANCH DERMATOLOGY
Street 4721 CHACE CIR
City HOOVER
State AL
ZIP 35244
Phone 205 266-9011
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2025
Certificate Expiration Date 6/3/2027
Facility Type Physician Office
Lab Director AMENA ALKESWANI

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