25D2048983 CLIA NUMBER - LACKEY PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 25D2048983
  • Facility Name: LACKEY PEDIATRIC CLINIC
  • Facility Address: 1 MEDICAL LANE
    FOREST, MS
    ZIP 39074
  • Facility Phone: 601 469-3320
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MOHOMMAD ARAIN
  • NPI Number: 1154670719
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2048983
LAB Type Physician Office
Facility Name LACKEY PEDIATRIC CLINIC
Street 1 MEDICAL LANE
City FOREST
State MS
ZIP 39074
Phone 601 469-3320
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Physician Office
Lab Director DR. MOHOMMAD ARAIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025