10D2280507 CLIA NUMBER - BOLD CITY DERMATOLOGY LLC

Laboratory Demographics

  • CLIA Code: 10D2280507
  • Facility Name: BOLD CITY DERMATOLOGY LLC
  • Facility Address: 120 GATEWAY CIRCLE UNIT 1
    JACKSONVILLE, FL
    ZIP 32259
  • Facility Phone: 904 544-5800
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: BISHR A. AL-DABAGH
  • NPI Number: 1538761655
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 10D2280507
LAB Type Physician Office
Facility Name BOLD CITY DERMATOLOGY LLC
Street 120 GATEWAY CIRCLE UNIT 1
City JACKSONVILLE
State FL
ZIP 32259
Phone 904 544-5800
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 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type Physician Office
Lab Director BISHR A. AL-DABAGH

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