Organization
MEDI-LAB DIAGNOSTICS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKIA JANEL GAINES (LABORATORY DIRECTOR)
(804) 896-6177
Entity
Organization
Contact information
Practice address
1617 25TH AVE, GULFPORT, MS 39501-2834
(804) 896-6177
Mailing address
1617 25TH AVE, GULFPORT, MS 39501-2834
(804) 896-6177
(804) 451-4739
Taxonomy
Speciality
Code
Description
License number
State
207SM0001X
Molecular Genetic Pathology (Medical Genetics) Physician
—
—
261QH0100X
Health Service Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
08/24/2022
Last updated
09/18/2023
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