11D0699583 CLIA NUMBER - SOUTHWEST GEORGIA DERMATOLOGY, PC

Laboratory Demographics

CLIA Number: 11D0699583

Facility Name: SOUTHWEST GEORGIA DERMATOLOGY, PC

Facility Address:
2401 OSLER COURT
ALBANY, GA
ZIP 31707
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Facility Phone Number: 229 889-1827

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1508076969

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	11D0699583
LAB Type	Physician Office
Facility Name	SOUTHWEST GEORGIA DERMATOLOGY, PC
Street	2401 OSLER COURT
City	ALBANY
State	GA
ZIP	31707
Phone	229 889-1827
CertificateType	3
CertificateEffectiveDate	3/1/2023
CertificateExpirationDate	2/28/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024