25D1011770 CLIA NUMBER - SULLIVAN FAMILY MEDICINE CLINIC

Laboratory Demographics

  • CLIA Code: 25D1011770
  • Facility Name: SULLIVAN FAMILY MEDICINE CLINIC
  • Facility Address: 1814 HOSPITAL DRIVE
    JACKSON, MS
    ZIP 39204
  • Facility Phone: 601 373-2940
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HURSIE J. DAVIS-SULLIVAN
  • NPI Number: 1215933346
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1011770
LAB Type Physician Office
Facility Name SULLIVAN FAMILY MEDICINE CLINIC
Street 1814 HOSPITAL DRIVE
City JACKSON
State MS
ZIP 39204
Phone 601 373-2940
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Physician Office
Lab Director HURSIE J. DAVIS-SULLIVAN

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