11D0906008 CLIA NUMBER - BAUCOM AND MINA DERM SURGERY, LLC

Laboratory Demographics

  • CLIA Code: 11D0906008
  • Facility Name: BAUCOM AND MINA DERM SURGERY, LLC
  • Facility Address: 5555 PEACHTREE DUNWOODY ROAD SUITE 206
    ATLANTA, GA
    ZIP 30342
  • Facility Phone: 404 844-0496
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MARK F. BAUCOM
  • NPI Number: 1245780980
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 11D0906008
LAB Type Physician Office
Facility Name BAUCOM AND MINA DERM SURGERY, LLC
Street 5555 PEACHTREE DUNWOODY ROAD SUITE 206
City ATLANTA
State GA
ZIP 30342
Phone 404 844-0496
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 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Physician Office
Lab Director MARK F. BAUCOM

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