25D2007449 CLIA NUMBER - SOUTHERN UROLOGY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 25D2007449
  • Facility Name: SOUTHERN UROLOGY SURGERY CENTER
  • Facility Address: 139 FAIRFIELD DRIVE SECOND FLOOR
    HATTIESBURG, MS
    ZIP 39402
  • Facility Phone: 601 450-2501
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. DEBORAH T. AZAR
  • NPI Number: 1023383569
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 25D2007449
LAB Type Ambulatory Surgery Center
Facility Name SOUTHERN UROLOGY SURGERY CENTER
Street 139 FAIRFIELD DRIVE SECOND FLOOR
City HATTIESBURG
State MS
ZIP 39402
Phone 601 450-2501
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2024
Certificate Expiration Date 5/17/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. DEBORAH T. AZAR

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