25D2061911 CLIA NUMBER - SOUTHERN PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 25D2061911
  • Facility Name: SOUTHERN PRIMARY CARE, PLLC
  • Facility Address: 327 N JACKSON ST
    BROOKHAVEN, MS
    ZIP 39601
  • Facility Phone: 601 833-3800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARTY K. BALLARD
  • NPI Number: 1891083135
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2061911
LAB Type Physician Office
Facility Name SOUTHERN PRIMARY CARE, PLLC
Street 327 N JACKSON ST
City BROOKHAVEN
State MS
ZIP 39601
Phone 601 833-3800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2025
Certificate Expiration Date 7/7/2027
Facility Type Physician Office
Lab Director MARTY K. BALLARD

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