25D2150882 CLIA NUMBER - FAMILY MEDICINE RESIDENCY CLINIC

Laboratory Demographics

  • CLIA Code: 25D2150882
  • Facility Name: FAMILY MEDICINE RESIDENCY CLINIC
  • Facility Address: 415 S 28TH AVENUE
    HATTIESBURG, MS
    ZIP 39401
  • Facility Phone: 601 579-3300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ERIC T. HALE
  • NPI Number: 1699267625
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2150882
LAB Type Physician Office
Facility Name FAMILY MEDICINE RESIDENCY CLINIC
Street 415 S 28TH AVENUE
City HATTIESBURG
State MS
ZIP 39401
Phone 601 579-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Physician Office
Lab Director DR. ERIC T. HALE

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