25D0989851 CLIA NUMBER - JACKSON PEDIATRIC ASSOCIATES

Laboratory Demographics

  • CLIA Code: 25D0989851
  • Facility Name: JACKSON PEDIATRIC ASSOCIATES
  • Facility Address: 297 HWY 51 SUITE B
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 601 707-5381
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. YOLANDA W. WILSON
  • NPI Number: 1659556298
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 25D0989851
LAB Type Physician Office
Facility Name JACKSON PEDIATRIC ASSOCIATES
Street 297 HWY 51 SUITE B
City RIDGELAND
State MS
ZIP 39157
Phone 601 707-5381
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2024
Certificate Expiration Date 3/7/2026
Facility Type Physician Office
Lab Director DR. YOLANDA W. WILSON

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This page was last updated on: 3/20/2025