Macon Clinical Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MACON CLINICAL LABORATORY, INC.

Practice address

602 Njefferson Street
Macon, MS 39341

Phone

(662) 726-5831

Fax

(662) 726-4638

NPI assigned

Feb 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ernest Roy Stuart

Title

Administrator

Phone

(662) 726-5831

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255473906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306",
            "city": "MACON",
            "state": "MS",
            "postal_code": "393410306",
            "telephone_number": "662-726-5831",
            "fax_number": "662-726-4638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 NJEFFERSON STREET",
            "city": "MACON",
            "state": "MS",
            "postal_code": "39341",
            "telephone_number": "662-726-5831",
            "fax_number": "662-726-4638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON CLINICAL LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-726-5831"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120680",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janice G Lathan, MS
• Yanci Lavender
• Philip S. Lee, MD
• Macon City Drug Store, Inc. (City Drug Store)
• Macon City Drug Store, Inc. (City Drug Store)
• James R Medlin, MD
• MHS, Inc. (Macon Medical Clinic)
• Royce Vandiver Miles Jr.
• Mississippi State Department of Health
• Mitchell Dental Clinic, Inc

• Clinical Medical Laboratory in Macon, MS
• Providers in Macon, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.