25D1104969 CLIA NUMBER - BETHANY R HAIRSTON MD PLLC DBA VITALITY DERMATOLOG

Laboratory Demographics

  • CLIA Code: 25D1104969
  • Facility Name: BETHANY R HAIRSTON MD PLLC DBA VITALITY DERMATOLOG
  • Facility Address: 724 LEIGH DRIVE
    COLUMBUS, MS
    ZIP 39705
  • Facility Phone: 662 328-3375
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: BETHANY HAIRSTON
  • NPI Number: 1871513721
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 25D1104969
LAB Type Physician Office
Facility Name BETHANY R HAIRSTON MD PLLC DBA VITALITY DERMATOLOG
Street 724 LEIGH DRIVE
City COLUMBUS
State MS
ZIP 39705
Phone 662 328-3375
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/26/2024
Certificate Expiration Date 1/25/2026
Facility Type Physician Office
Lab Director BETHANY HAIRSTON

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