25D0966300 CLIA NUMBER - JACKSON HEART CLINIC

Laboratory Demographics

CLIA Number: 25D0966300

Facility Name: JACKSON HEART CLINIC

Facility Address:
970 LAKELAND DRIVE SUITE 61
JACKSON, MS
ZIP 39216
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Facility Phone Number: 601 982-7850

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1659318558

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

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
CertificateType	4
CertificateEffectiveDate	7/14/2022
CertificateExpirationDate	7/13/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024