25D2019409 CLIA NUMBER - PETAL URGENT CARE CLINIC

Laboratory Demographics

  • CLIA Code: 25D2019409
  • Facility Name: PETAL URGENT CARE CLINIC
  • Facility Address: 1272 EVELYN GANDY PARKWAY STE 60
    PETAL, MS
    ZIP 39465
  • Facility Phone: 601 336-5393
  • Facility Type: Other - URGENT CARE
  • Facility Type: Waiver
  • Lab Director: RONNIE ALI
  • NPI Number: 1982908877
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2019409
LAB Type Other - URGENT CARE
Facility Name PETAL URGENT CARE CLINIC
Street 1272 EVELYN GANDY PARKWAY STE 60
City PETAL
State MS
ZIP 39465
Phone 601 336-5393
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Other - URGENT CARE
Lab Director RONNIE ALI

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