Healthcare Provider Details

I. General information

NPI: 1336070267
Provider Name (Legal Business Name): DESOTO DNA AND DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 MAIN ST
SOUTHAVEN MS
38671-1237
US

IV. Provider business mailing address

1668 MAIN ST
SOUTHAVEN MS
38671-1237
US

V. Phone/Fax

Practice location:
  • Phone: 662-856-9854
  • Fax: 901-860-4413
Mailing address:
  • Phone: 662-856-9854
  • Fax: 901-860-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAKASHI Y LABON
Title or Position: OWNER/PHLEBOTOMIST
Credential:
Phone: 901-864-9086