11D0934752 CLIA NUMBER - FAYETTE AREA DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 11D0934752
  • Facility Name: FAYETTE AREA DERMATOLOGY
  • Facility Address: 450 LANIER AVE WEST
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 460-8988
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JAMES T. SANDWICH
  • NPI Number: 1073624763
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D0934752
LAB Type Physician Office
Facility Name FAYETTE AREA DERMATOLOGY
Street 450 LANIER AVE WEST
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 460-8988
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 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Physician Office
Lab Director JAMES T. SANDWICH

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