19D2269178 CLIA NUMBER - SOUTHERN SPROUTS PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 19D2269178
  • Facility Name: SOUTHERN SPROUTS PEDIATRICS LLC
  • Facility Address: 217 BREVARD COURT, SUITE D
    ALEXANDRIA, LA
    ZIP 71303
  • Facility Phone: 318 777-6887
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAMELA DORRIS FREEMAN
  • NPI Number: 1730808866
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 19D2269178
LAB Type Physician Office
Facility Name SOUTHERN SPROUTS PEDIATRICS LLC
Street 217 BREVARD COURT, SUITE D
City ALEXANDRIA
State LA
ZIP 71303
Phone 318 777-6887
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Physician Office
Lab Director PAMELA DORRIS FREEMAN

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