25D0891021 CLIA NUMBER - CHARLESTON CLINIC

Laboratory Demographics

  • CLIA Code: 25D0891021
  • Facility Name: CHARLESTON CLINIC
  • Facility Address: FOUR HUNDRED AND ONE SOUTH CHURCH
    CHARLESTON, MS
    ZIP 38921
  • Facility Phone: 662 647-5816
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: KELLIE D. JONES MLT
  • NPI Number: 1831329887
  • Taxonomy: 363LC1500X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D0891021
LAB Type Other
Facility Name CHARLESTON CLINIC
Street FOUR HUNDRED AND ONE SOUTH CHURCH
City CHARLESTON
State MS
ZIP 38921
Phone 662 647-5816
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2024
Certificate Expiration Date 8/29/2026
Facility Type Other
Lab Director KELLIE D. JONES MLT

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