34D0913719 CLIA NUMBER - SOUTHERN HIGH SCHOOL WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 34D0913719
  • Facility Name: SOUTHERN HIGH SCHOOL WELLNESS CENTER
  • Facility Address: 800 CLAYTON ROAD
    DURHAM, NC
    ZIP 27703
  • Facility Phone: 919 560-2536
  • Facility Type: School/Student Health Service
  • Facility Type: Microscopy
  • Lab Director: JAMIE E. MANCUSO
  • NPI Number: 1972826568
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D0913719
LAB Type School/Student Health Service
Facility Name SOUTHERN HIGH SCHOOL WELLNESS CENTER
Street 800 CLAYTON ROAD
City DURHAM
State NC
ZIP 27703
Phone 919 560-2536
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/9/2024
Certificate Expiration Date 4/8/2026
Facility Type School/Student Health Service
Lab Director JAMIE E. MANCUSO

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