25D2277736 CLIA NUMBER - 4D HEALTHCARE

Laboratory Demographics

  • CLIA Code: 25D2277736
  • Facility Name: 4D HEALTHCARE
  • Facility Address: 1324 MILITARY RD
    COLUMBUS, MS
    ZIP 39701
  • Facility Phone: 662 630-5001
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TANYA S. COCKRELL
  • NPI Number: 1164129755
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2277736
LAB Type Practitioner Other
Facility Name 4D HEALTHCARE
Street 1324 MILITARY RD
City COLUMBUS
State MS
ZIP 39701
Phone 662 630-5001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Practitioner Other
Lab Director TANYA S. COCKRELL

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