04D1052897 CLIA NUMBER - JOHNSON DERMATOLOGY CLINIC, PLLC

Laboratory Demographics

  • CLIA Code: 04D1052897
  • Facility Name: JOHNSON DERMATOLOGY CLINIC, PLLC
  • Facility Address: 5921 RILEY PARK DRIVE
    FORT SMITH, AR
    ZIP 72916
  • Facility Phone: 479 649-3376
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. AMY R. HUDSON
  • NPI Number: 1437110962
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 04D1052897
LAB Type Physician Office
Facility Name JOHNSON DERMATOLOGY CLINIC, PLLC
Street 5921 RILEY PARK DRIVE
City FORT SMITH
State AR
ZIP 72916
Phone 479 649-3376
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 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Physician Office
Lab Director DR. AMY R. HUDSON

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