25D2096426 CLIA NUMBER - GULF COAST LIFE, PLLC

Laboratory Demographics

  • CLIA Code: 25D2096426
  • Facility Name: GULF COAST LIFE, PLLC
  • Facility Address: 4405 E ALOHA DRIVE
    DIAMONDHEAD, MS
    ZIP 39525
  • Facility Phone: 228 255-8818
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERIN A. DEWITT
  • NPI Number: 1700264025
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2096426
LAB Type Physician Office
Facility Name GULF COAST LIFE, PLLC
Street 4405 E ALOHA DRIVE
City DIAMONDHEAD
State MS
ZIP 39525
Phone 228 255-8818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Physician Office
Lab Director ERIN A. DEWITT

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