25D2328565 CLIA NUMBER - JOHNSON DIAGNOSTIC SERVICES LLC

Laboratory Demographics

  • CLIA Code: 25D2328565
  • Facility Name: JOHNSON DIAGNOSTIC SERVICES LLC
  • Facility Address: 121 FRONT ST
    PURVIS, MS
    ZIP 39475
  • Facility Phone: 833 385-3874
  • Facility Type: Other - PRIVATE AGENCY
  • Facility Type: Waiver
  • Lab Director: WANKETHIA JOHNSON
  • NPI Number: 1477448249
  • Taxonomy: 253Z00000X - In Home Supportive Care

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CLIA Record

Field Name Field Value
CLIA Number 25D2328565
LAB Type Other - PRIVATE AGENCY
Facility Name JOHNSON DIAGNOSTIC SERVICES LLC
Street 121 FRONT ST
City PURVIS
State MS
ZIP 39475
Phone 833 385-3874
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Other - PRIVATE AGENCY
Lab Director WANKETHIA JOHNSON

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