25D2186591 CLIA NUMBER - MILESTONES PEDIATRIC CLINIC LLC

Laboratory Demographics

  • CLIA Code: 25D2186591
  • Facility Name: MILESTONES PEDIATRIC CLINIC LLC
  • Facility Address: 224B S CHURCH ST
    BROOKHAVEN, MS
    ZIP 39601
  • Facility Phone: 601 757-2060
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ASHLEY H. HICKMAN
  • NPI Number: 1114543980
  • Taxonomy: 363LP0200X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2186591
LAB Type Practitioner Other
Facility Name MILESTONES PEDIATRIC CLINIC LLC
Street 224B S CHURCH ST
City BROOKHAVEN
State MS
ZIP 39601
Phone 601 757-2060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type Practitioner Other
Lab Director ASHLEY H. HICKMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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