01D2089501 CLIA NUMBER - SIA DERMATOLOGY/MOHS LAB

Laboratory Demographics

  • CLIA Code: 01D2089501
  • Facility Name: SIA DERMATOLOGY/MOHS LAB
  • Facility Address: 1733 WEST MAIN STREET, SUITE 500
    DOTHAN, AL
    ZIP 36301
  • Facility Phone: 334 699-7546
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ANGELA L. BOOKOUT
  • NPI Number: 1386044543
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 01D2089501
LAB Type Physician Office
Facility Name SIA DERMATOLOGY/MOHS LAB
Street 1733 WEST MAIN STREET, SUITE 500
City DOTHAN
State AL
ZIP 36301
Phone 334 699-7546
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/14/2023
Certificate Expiration Date 6/30/2025
Facility Type Physician Office
Lab Director ANGELA L. BOOKOUT

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This page was last updated on: 6/4/2025