25D0693226 CLIA NUMBER - JACKSON NORTH DIALYSIS

Laboratory Demographics

  • CLIA Code: 25D0693226
  • Facility Name: JACKSON NORTH DIALYSIS
  • Facility Address: 571 EAST BEASLEY ROAD SUITE A
    JACKSON, MS
    ZIP 39206
  • Facility Phone: 601 957-1999
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BABTUNDE OLUTADE
  • NPI Number: 1982659264
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0693226
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JACKSON NORTH DIALYSIS
Street 571 EAST BEASLEY ROAD SUITE A
City JACKSON
State MS
ZIP 39206
Phone 601 957-1999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BABTUNDE OLUTADE

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