10D0677280 CLIA NUMBER - JACKSON COUNTY HEALTH DEPARTMENT

Laboratory Demographics

  • CLIA Code: 10D0677280
  • Facility Name: JACKSON COUNTY HEALTH DEPARTMENT
  • Facility Address: 4979 HEALTHY WAY ATTN ALICE PATE
    MARIANNA, FL
    ZIP 32446
  • Facility Phone: 850 526-2412
  • Facility Type: Public Health Laboratories
  • Facility Type: Microscopy
  • Lab Director: KONGSAK CHANTORNSAENG
  • NPI Number: 1417034836
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 10D0677280
LAB Type Public Health Laboratories
Facility Name JACKSON COUNTY HEALTH DEPARTMENT
Street 4979 HEALTHY WAY ATTN ALICE PATE
City MARIANNA
State FL
ZIP 32446
Phone 850 526-2412
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 1/9/2025
Certificate Expiration Date 1/8/2027
Facility Type Public Health Laboratories
Lab Director KONGSAK CHANTORNSAENG

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