25D2006834 CLIA NUMBER - DIVA WEIGHT LOSS LLC DBA PERFORMANCE WEIGHT LOSS AND MEDI SPA

Laboratory Demographics

  • CLIA Code: 25D2006834
  • Facility Name: DIVA WEIGHT LOSS LLC DBA PERFORMANCE WEIGHT LOSS AND MEDI SPA
  • Facility Address: 680 HIGHWAY 51, SUITE D
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 769 251-1040
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALISON JOHNSON
  • NPI Number: 1417230186
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2006834
LAB Type Physician Office
Facility Name DIVA WEIGHT LOSS LLC DBA PERFORMANCE WEIGHT LOSS AND MEDI SPA
Street 680 HIGHWAY 51, SUITE D
City RIDGELAND
State MS
ZIP 39157
Phone 769 251-1040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2024
Certificate Expiration Date 4/29/2026
Facility Type Physician Office
Lab Director ALISON JOHNSON

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