25D0966300 CLIA NUMBER - JACKSON HEART CLINIC

Laboratory Demographics

  • CLIA Code: 25D0966300
  • Facility Name: JACKSON HEART CLINIC
  • Facility Address: 970 LAKELAND DRIVE SUITE 61
    JACKSON, MS
    ZIP 39216
  • Facility Phone: 601 982-7850
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JIMMY D. LOTT
  • NPI Number: 1659318558
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D0966300
LAB Type Physician Office
Facility Name JACKSON HEART CLINIC
Street 970 LAKELAND DRIVE SUITE 61
City JACKSON
State MS
ZIP 39216
Phone 601 982-7850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Physician Office
Lab Director JIMMY D. LOTT

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