25D2225776 CLIA NUMBER - NORTH MISSISSIPPI MEDICAL CENTER SPECIALTY CLINIC

Laboratory Demographics

CLIA Number: 25D2225776

Facility Name: NORTH MISSISSIPPI MEDICAL CENTER SPECIALTY CLINIC

Facility Address:
3302 W LINDEN ST
CORINTH, MS
ZIP 38834
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Facility Phone Number: 662 331-1956

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740957216

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name	Field Value
CLIA Number	25D2225776
LAB Type	Physician Office
Facility Name	NORTH MISSISSIPPI MEDICAL CENTER SPECIALTY CLINIC
Street	3302 W LINDEN ST
City	CORINTH
State	MS
ZIP	38834
Phone	662 331-1956
CertificateType	4
CertificateEffectiveDate	5/24/2023
CertificateExpirationDate	5/23/2025
FacilityType	Waiver

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