25D2198387 CLIA NUMBER - SOUTHERN GRACE PSYCHIATRY

Laboratory Demographics

  • CLIA Code: 25D2198387
  • Facility Name: SOUTHERN GRACE PSYCHIATRY
  • Facility Address: 5699 GETWELL ROAD, BLDG F, SUITE 5
    SOUTHAVEN, MS
    ZIP 38672
  • Facility Phone: 662 649-6502
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TERESA D. KENDRICK
  • NPI Number: 1184251795
  • Taxonomy: 363LP0808X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2198387
LAB Type Practitioner Other
Facility Name SOUTHERN GRACE PSYCHIATRY
Street 5699 GETWELL ROAD, BLDG F, SUITE 5
City SOUTHAVEN
State MS
ZIP 38672
Phone 662 649-6502
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Practitioner Other
Lab Director TERESA D. KENDRICK

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