25D2324307 CLIA NUMBER - PERSONIC MISSISSIPPI PLLC

Laboratory Demographics

  • CLIA Code: 25D2324307
  • Facility Name: PERSONIC MISSISSIPPI PLLC
  • Facility Address: 317 E CAPITOL ST STE 200
    JACKSON, MS
    ZIP 39201
  • Facility Phone: 855 479-4217
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD COOK
  • NPI Number: 1043017452
  • Taxonomy: 163WW0000X - Registered Nurse

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CLIA Record

Field Name Field Value
CLIA Number 25D2324307
LAB Type Physician Office
Facility Name PERSONIC MISSISSIPPI PLLC
Street 317 E CAPITOL ST STE 200
City JACKSON
State MS
ZIP 39201
Phone 855 479-4217
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Physician Office
Lab Director RICHARD COOK

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