25D0976601 CLIA NUMBER - GULFPORT JOB CORPS CENTER/WELLNESS

Laboratory Demographics

  • CLIA Code: 25D0976601
  • Facility Name: GULFPORT JOB CORPS CENTER/WELLNESS
  • Facility Address: 3300 20TH STREET BUILDING # 3
    GULFPORT, MS
    ZIP 39501
  • Facility Phone: 228 870-7225
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: LILLIE GRAVES
  • NPI Number: 1467660407
  • Taxonomy: 163WS0200X - Registered Nurse

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D0976601
LAB Type School/Student Health Service
Facility Name GULFPORT JOB CORPS CENTER/WELLNESS
Street 3300 20TH STREET BUILDING # 3
City GULFPORT
State MS
ZIP 39501
Phone 228 870-7225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type School/Student Health Service
Lab Director LILLIE GRAVES

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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