25D2116361 CLIA NUMBER - FAMILY CLINIC ON ADELINE

Laboratory Demographics

  • CLIA Code: 25D2116361
  • Facility Name: FAMILY CLINIC ON ADELINE
  • Facility Address: 1501 ADELINE ST STE 3
    HATTIESBURG, MS
    ZIP 39401
  • Facility Phone: 601 336-8970
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARLA MATHIS
  • NPI Number: 1972662427
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2116361
LAB Type Practitioner Other
Facility Name FAMILY CLINIC ON ADELINE
Street 1501 ADELINE ST STE 3
City HATTIESBURG
State MS
ZIP 39401
Phone 601 336-8970
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2024
Certificate Expiration Date 7/24/2026
Facility Type Practitioner Other
Lab Director MARLA MATHIS

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