11D1073390 CLIA NUMBER - PETERSON DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 11D1073390
  • Facility Name: PETERSON DERMATOLOGY
  • Facility Address: 305 FIRST STREET WEST
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 538-9080
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: LETTY R. PETERSON
  • NPI Number: 1932300886
  • Taxonomy: 207N00000X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1073390
LAB Type Physician Office
Facility Name PETERSON DERMATOLOGY
Street 305 FIRST STREET WEST
City VIDALIA
State GA
ZIP 30474
Phone 912 538-9080
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 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Physician Office
Lab Director LETTY R. PETERSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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