25D2300636 CLIA NUMBER - MAG MEDICAL & MEDISPA

Laboratory Demographics

  • CLIA Code: 25D2300636
  • Facility Name: MAG MEDICAL & MEDISPA
  • Facility Address: 307 NORTH UNION STREET
    RIPLEY, MS
    ZIP 38663
  • Facility Phone: 662 507-2903
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LAURA KIRKMAN
  • NPI Number: 1780449389
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2300636
LAB Type Practitioner Other
Facility Name MAG MEDICAL & MEDISPA
Street 307 NORTH UNION STREET
City RIPLEY
State MS
ZIP 38663
Phone 662 507-2903
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2024
Certificate Expiration Date 3/12/2026
Facility Type Practitioner Other
Lab Director LAURA KIRKMAN

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