25D2249248 CLIA NUMBER - PREMIER FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 25D2249248
  • Facility Name: PREMIER FAMILY PRACTICE LLC
  • Facility Address: 219 8TH ST N
    COLUMBUS, MS
    ZIP 39701
  • Facility Phone: 662 610-4966
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALICIA P. DAVIS
  • NPI Number: 1023779808
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2249248
LAB Type Physician Office
Facility Name PREMIER FAMILY PRACTICE LLC
Street 219 8TH ST N
City COLUMBUS
State MS
ZIP 39701
Phone 662 610-4966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Physician Office
Lab Director ALICIA P. DAVIS

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