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General NPI Number Information
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NPI Number | 1851046999
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Entity Type | Individual
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Provider Name | LAKIA JANEL GAINES
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Gender | Female
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 10324 SWEET BAY DR
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City | GULFPORT
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State | MS
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Zip | 39503-7520
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Country | US
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Telephone | 804-896-6177
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Fax | 804-451-4739
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Provider Business Mailing Address
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Address Line | 10324 SWEET BAY DR
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City | GULFPORT
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State | MS
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Zip | 39503-7520
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Country | US
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Telephone | 804-436-2511
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Fax | 804-451-4739
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | 1325103
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License Number State | MS
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