04D2115497 CLIA NUMBER - PINNACLE DERMATOLOGY PRIME MEDICAL GROUP PLLC

Laboratory Demographics

  • CLIA Code: 04D2115497
  • Facility Name: PINNACLE DERMATOLOGY PRIME MEDICAL GROUP PLLC
  • Facility Address: 16115 ST VINCENT WAY SUITE 300
    LITTLE ROCK, AR
    ZIP 72223
  • Facility Phone: 501 817-3923
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. ANDREA MABRY
  • NPI Number: 1386168581
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2115497
LAB Type Physician Office
Facility Name PINNACLE DERMATOLOGY PRIME MEDICAL GROUP PLLC
Street 16115 ST VINCENT WAY SUITE 300
City LITTLE ROCK
State AR
ZIP 72223
Phone 501 817-3923
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 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Physician Office
Lab Director DR. ANDREA MABRY

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