25D2043399 CLIA NUMBER - SOUTHERN FAMILY URGENT CARE

Laboratory Demographics

  • CLIA Code: 25D2043399
  • Facility Name: SOUTHERN FAMILY URGENT CARE
  • Facility Address: 1212 EAST PASS ROAD
    GULFPORT, MS
    ZIP 39507
  • Facility Phone: 251 510-8170
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AMANDA R. MIZELL
  • NPI Number: 1891852042
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 25D2043399
LAB Type Practitioner Other
Facility Name SOUTHERN FAMILY URGENT CARE
Street 1212 EAST PASS ROAD
City GULFPORT
State MS
ZIP 39507
Phone 251 510-8170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2024
Certificate Expiration Date 7/1/2026
Facility Type Practitioner Other
Lab Director AMANDA R. MIZELL

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