19D2153570 CLIA NUMBER - MMG/NELSON RD

Laboratory Demographics

  • CLIA Code: 19D2153570
  • Facility Name: MMG/NELSON RD
  • Facility Address: 4345 NELSON ROAD
    LAKE CHARLES, LA
    ZIP 70605
  • Facility Phone: 337 480-7900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHSH WHATLEY
  • NPI Number: 1295103844
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 19D2153570
LAB Type Physician Office
Facility Name MMG/NELSON RD
Street 4345 NELSON ROAD
City LAKE CHARLES
State LA
ZIP 70605
Phone 337 480-7900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Physician Office
Lab Director JOHSH WHATLEY

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