25D2003324 CLIA NUMBER - GOLDEN AGE CLINIC

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Laboratory Demographics

CLIA Number: 25D2003324

Facility Name: GOLDEN AGE CLINIC

Facility Address:
2901 HIGHWAY 82 EAST
GREENWOOD, MS
ZIP 38930
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Facility Phone Number: 662 374-2185

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558693671

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2003324
LAB Type	Physician Office
Facility Name	GOLDEN AGE CLINIC
Street	2901 HIGHWAY 82 EAST
City	GREENWOOD
State	MS
ZIP	38930
Phone	662 374-2185
CertificateType	4
CertificateEffectiveDate	2/5/2024
CertificateExpirationDate	2/4/2026
FacilityType	Waiver

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