25D2022088 CLIA NUMBER - 4 THE FAMILY HEALTHCARE

Laboratory Demographics

  • CLIA Code: 25D2022088
  • Facility Name: 4 THE FAMILY HEALTHCARE
  • Facility Address: 1127 OLD FANNIN ROAD, C
    BRANDON, MS
    ZIP 39047
  • Facility Phone: 601 919-1090
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: NIETA ALLEN
  • NPI Number: 1184913014
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2022088
LAB Type Practitioner Other
Facility Name 4 THE FAMILY HEALTHCARE
Street 1127 OLD FANNIN ROAD, C
City BRANDON
State MS
ZIP 39047
Phone 601 919-1090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type Practitioner Other
Lab Director NIETA ALLEN

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