25D1007211 CLIA NUMBER - PRENTISS PRIMARY CARE PA

Laboratory Demographics

  • CLIA Code: 25D1007211
  • Facility Name: PRENTISS PRIMARY CARE PA
  • Facility Address: 1529 COLUMBIA AVENUE
    PRENTISS, MS
    ZIP 39474
  • Facility Phone: 601 792-3200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JAISHANKAR JAGADEESAN
  • NPI Number: 1902129455
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D1007211
LAB Type Physician Office
Facility Name PRENTISS PRIMARY CARE PA
Street 1529 COLUMBIA AVENUE
City PRENTISS
State MS
ZIP 39474
Phone 601 792-3200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director DR. JAISHANKAR JAGADEESAN

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