25D2176339 CLIA NUMBER - MCCOMB CHILDREN'S CLINIC

Laboratory Demographics

  • CLIA Code: 25D2176339
  • Facility Name: MCCOMB CHILDREN'S CLINIC
  • Facility Address: 4860 PLAZA DR
    TYLERTOWN, MS
    ZIP 39667
  • Facility Phone: 601 684-7623
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICAH CRAFT
  • NPI Number: 1902888316
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 25D2176339
LAB Type Physician Office
Facility Name MCCOMB CHILDREN'S CLINIC
Street 4860 PLAZA DR
City TYLERTOWN
State MS
ZIP 39667
Phone 601 684-7623
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2023
Certificate Expiration Date 12/11/2025
Facility Type Physician Office
Lab Director MICAH CRAFT

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