Organization
LIFELINE DIAGNOSTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILMALEAN MICHELLE BLACK (OWNER)
(601) 850-1012
Entity
Organization
Contact information
Practice address
2506 39TH ST APT 68, MERIDIAN, MS 39305-3887
(601) 850-1012
Mailing address
2506 39TH ST APT 68, MERIDIAN, MS 39305-3887
(601) 850-1012
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/08/2024
Last updated
01/30/2024
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