Organization
MACON CLINICAL LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST ROY STUART (ADMINISTRATOR)
(662) 726-5831
Entity
Organization
Contact information
Practice address
602 NJEFFERSON STREET, MACON, MS 39341
(662) 726-5831
(662) 726-4638
Mailing address
PO BOX 306, MACON, MS 39341-0306
(662) 726-5831
(662) 726-4638
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120680
—
MS
Enumeration date
02/12/2007
Last updated
08/22/2020
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