25D2272221 CLIA NUMBER - FAMILY MEDICAL CLINIC VARDAMAN

Laboratory Demographics

  • CLIA Code: 25D2272221
  • Facility Name: FAMILY MEDICAL CLINIC VARDAMAN
  • Facility Address: 310 W SWEET POTATO ST STE B
    VARDAMAN, MS
    ZIP 38878
  • Facility Phone: 662 567-1282
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: AMANDA B. MAHAN
  • NPI Number: 1467177683
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2272221
LAB Type Community Clinic
Facility Name FAMILY MEDICAL CLINIC VARDAMAN
Street 310 W SWEET POTATO ST STE B
City VARDAMAN
State MS
ZIP 38878
Phone 662 567-1282
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Community Clinic
Lab Director AMANDA B. MAHAN

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