25D0944715 CLIA NUMBER - WOODLAND CLINIC LLC

Laboratory Demographics

  • CLIA Code: 25D0944715
  • Facility Name: WOODLAND CLINIC LLC
  • Facility Address: 120 MARKET STREET
    WOODLAND, MS
    ZIP 39776
  • Facility Phone: 662 456-0111
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: JERRIE L. SULLIVAN
  • NPI Number: 1578081410
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0944715
LAB Type Practitioner Other
Facility Name WOODLAND CLINIC LLC
Street 120 MARKET STREET
City WOODLAND
State MS
ZIP 39776
Phone 662 456-0111
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 4/17/2024
Certificate Expiration Date 4/16/2026
Facility Type Practitioner Other
Lab Director JERRIE L. SULLIVAN

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