25D2307662 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE-JACKSON WEST

Laboratory Demographics

  • CLIA Code: 25D2307662
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE-JACKSON WEST
  • Facility Address: 4890 HIGHWAY 18 W UNIT A
    JACKSON, MS
    ZIP 39209
  • Facility Phone: 601 301-5385
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. EARL K. MAGEE
  • NPI Number: 1821864174
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2307662
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE-JACKSON WEST
Street 4890 HIGHWAY 18 W UNIT A
City JACKSON
State MS
ZIP 39209
Phone 601 301-5385
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Physician Office
Lab Director DR. EARL K. MAGEE

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