25D2286594 CLIA NUMBER - MILLENNIAL HEALTHCARE LLC

Laboratory Demographics

  • CLIA Code: 25D2286594
  • Facility Name: MILLENNIAL HEALTHCARE LLC
  • Facility Address: 15 NORTHTOWN DRIVE
    JACKSON, MS
    ZIP 39211
  • Facility Phone: 601 882-4878
  • Facility Type: Health Main. Organization
  • Facility Type: Waiver
  • Lab Director: DOMINIQUE J. BUCKNER
  • NPI Number: 1437852266
  • Taxonomy: 251J00000X - Nursing Care

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CLIA Record

Field Name Field Value
CLIA Number 25D2286594
LAB Type Health Main. Organization
Facility Name MILLENNIAL HEALTHCARE LLC
Street 15 NORTHTOWN DRIVE
City JACKSON
State MS
ZIP 39211
Phone 601 882-4878
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Health Main. Organization
Lab Director DOMINIQUE J. BUCKNER

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