Organization
DIAGNOSTIC TISSUE/CYTOLOGY GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN L. WILKINSON M.D. (PATHOLOGIST)
(601) 553-6809
Entity
Organization
Contact information
Practice address
1512 20TH AVE, MERIDIAN, MS 39301-4124
(601) 483-8300
(601) 484-7776
Mailing address
PO BOX 3780, TUPELO, MS 38803-3780
(601) 483-8300
(601) 484-7776
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
25D0318506
MS
291U00000X
Clinical Medical Laboratory
Primary
25D0651894
MS
291U00000X
Clinical Medical Laboratory
25D0980061
MS
291U00000X
Clinical Medical Laboratory
25D1011258
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07478777
—
MS
05
—
690000005
—
AL
01
—
P00132040
MEDICARE RAILROAD
MS
Enumeration date
08/31/2006
Last updated
01/20/2020
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