25D2129893 CLIA NUMBER - BRIDGEWATER PSYCHIATRY

Laboratory Demographics

  • CLIA Code: 25D2129893
  • Facility Name: BRIDGEWATER PSYCHIATRY
  • Facility Address: 8990 LORRAINE RD
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 331-3310
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RALPH L. BURROUGHS
  • NPI Number: 1013515451
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 25D2129893
LAB Type Physician Office
Facility Name BRIDGEWATER PSYCHIATRY
Street 8990 LORRAINE RD
City GULFPORT
State MS
ZIP 39503
Phone 228 331-3310
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Physician Office
Lab Director RALPH L. BURROUGHS

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