25D2302827 CLIA NUMBER - PEDIATRIC & ADOLESCENT CLINIC LLC

Laboratory Demographics

  • CLIA Code: 25D2302827
  • Facility Name: PEDIATRIC & ADOLESCENT CLINIC LLC
  • Facility Address: 107 NORTH MARTIN LUTHER KING JR STREET
    NATCHEZ, MS
    ZIP 39120
  • Facility Phone: 601 442-7676
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID A. TIMM
  • NPI Number: 1174608020
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2302827
LAB Type Physician Office
Facility Name PEDIATRIC & ADOLESCENT CLINIC LLC
Street 107 NORTH MARTIN LUTHER KING JR STREET
City NATCHEZ
State MS
ZIP 39120
Phone 601 442-7676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2024
Certificate Expiration Date 4/15/2026
Facility Type Physician Office
Lab Director DAVID A. TIMM

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