04D0468272 CLIA NUMBER - GEORGE W JACKSON MD

Laboratory Demographics

  • CLIA Code: 04D0468272
  • Facility Name: GEORGE W JACKSON MD
  • Facility Address: 1440 HWY 62/412
    HIGHLAND, AR
    ZIP 72542
  • Facility Phone: 870 856-6000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GEORGE W. JACKSON MD
  • NPI Number: 1497824304
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0468272
LAB Type Physician Office
Facility Name GEORGE W JACKSON MD
Street 1440 HWY 62/412
City HIGHLAND
State AR
ZIP 72542
Phone 870 856-6000
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director GEORGE W. JACKSON MD

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