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General NPI Number Information
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NPI Number | 1689328387
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Entity Type | Organization
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Legal Business Name | SLM LABS 2
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 547 SUNRISE RD
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City | PETAL
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State | MS
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Zip | 39465-9654
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Country | US
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Telephone | 228-493-9784
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Fax |
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Provider Business Mailing Address
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Address Line | 547 SUNRISE RD
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City | PETAL
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State | MS
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Zip | 39465-9654
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Country | US
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Telephone | 228-493-9784
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNA CLINTON MCCRORY
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Credential | OWNER
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Telephone | 228-493-9784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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