25D2014536 CLIA NUMBER - MAGNOLIA MEDICAL CLINIC - YAZOO

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Laboratory Demographics

CLIA Number: 25D2014536

Facility Name: MAGNOLIA MEDICAL CLINIC - YAZOO

Facility Address:
1435 GRAND AVENUE
YAZOO CITY, MS
ZIP 39194
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Facility Phone Number: 662 746-3555

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225320708

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2014536
LAB Type	Physician Office
Facility Name	MAGNOLIA MEDICAL CLINIC - YAZOO
Street	1435 GRAND AVENUE
City	YAZOO CITY
State	MS
ZIP	39194
Phone	662 746-3555
CertificateType	4
CertificateEffectiveDate	10/12/2022
CertificateExpirationDate	10/11/2024
FacilityType	Waiver

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