25D2182630 CLIA NUMBER - SOUTHERN FAMILY URGENT CARE LLC

Laboratory Demographics

  • CLIA Code: 25D2182630
  • Facility Name: SOUTHERN FAMILY URGENT CARE LLC
  • Facility Address: 12303 HWY 49 STE A
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 896-7108
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA R. MIZELL
  • NPI Number: 1144582040
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2182630
LAB Type Physician Office
Facility Name SOUTHERN FAMILY URGENT CARE LLC
Street 12303 HWY 49 STE A
City GULFPORT
State MS
ZIP 39503
Phone 228 896-7108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Physician Office
Lab Director AMANDA R. MIZELL

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