25D0317620 CLIA NUMBER - GREEN TREE FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 25D0317620
  • Facility Name: GREEN TREE FAMILY CLINIC
  • Facility Address: 603 E MAIN
    MOUNT OLIVE, MS
    ZIP 39119
  • Facility Phone: 601 797-3405
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WORD M. JOHNSTON
  • NPI Number: 1336447861
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0317620
LAB Type Physician Office
Facility Name GREEN TREE FAMILY CLINIC
Street 603 E MAIN
City MOUNT OLIVE
State MS
ZIP 39119
Phone 601 797-3405
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 WORD M. JOHNSTON

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