01D0960717 CLIA NUMBER - MONTGOMERY DERMATOLOGY PC

Laboratory Demographics

  • CLIA Code: 01D0960717
  • Facility Name: MONTGOMERY DERMATOLOGY PC
  • Facility Address: 4712 BERRY BOULEVARD
    MONTGOMERY, AL
    ZIP 36106
  • Facility Phone: 334 834-3094
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOHN L. ANTHONY
  • NPI Number: 1982877619
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 01D0960717
LAB Type Physician Office
Facility Name MONTGOMERY DERMATOLOGY PC
Street 4712 BERRY BOULEVARD
City MONTGOMERY
State AL
ZIP 36106
Phone 334 834-3094
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Physician Office
Lab Director JOHN L. ANTHONY

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This page was last updated on: 9/29/2025