25D0316717 CLIA NUMBER - DELTA KIDNEY ALLIANCE LLC

Laboratory Demographics

  • CLIA Code: 25D0316717
  • Facility Name: DELTA KIDNEY ALLIANCE LLC
  • Facility Address: 1502 S COLORADO ST STE 100
    GREENVILLE, MS
    ZIP 38703
  • Facility Phone: 662 335-4105
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. WILSON M. PARRY
  • NPI Number: 1992276851
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D0316717
LAB Type Physician Office
Facility Name DELTA KIDNEY ALLIANCE LLC
Street 1502 S COLORADO ST STE 100
City GREENVILLE
State MS
ZIP 38703
Phone 662 335-4105
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Physician Office
Lab Director DR. WILSON M. PARRY

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