11D0705493 CLIA NUMBER - PEACHTREE DERMATOLOGY ASSOCIATES

Laboratory Demographics

CLIA Number: 11D0705493

Facility Name: PEACHTREE DERMATOLOGY ASSOCIATES

Facility Address:
371 EAST PACES FERRY, NE, SUITE 900
ATLANTA, GA
ZIP 30305
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Facility Phone Number: 404 355-1919

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1316965213

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	11D0705493
LAB Type	Physician Office
Facility Name	PEACHTREE DERMATOLOGY ASSOCIATES
Street	371 EAST PACES FERRY, NE, SUITE 900
City	ATLANTA
State	GA
ZIP	30305
Phone	404 355-1919
CertificateType	3
CertificateEffectiveDate	12/11/2023
CertificateExpirationDate	12/10/2025
FacilityType	PPMP

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