11D1079494 CLIA NUMBER - DIPRETA DERMATOLOGY CLINIC

Laboratory Demographics

  • CLIA Code: 11D1079494
  • Facility Name: DIPRETA DERMATOLOGY CLINIC
  • Facility Address: 3008 EAST PARK AVENUE
    BRUNSWICK, GA
    ZIP 31520
  • Facility Phone: 912 265-2142
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD A. DIPRETA
  • NPI Number: 1821346651
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 11D1079494
LAB Type Physician Office
Facility Name DIPRETA DERMATOLOGY CLINIC
Street 3008 EAST PARK AVENUE
City BRUNSWICK
State GA
ZIP 31520
Phone 912 265-2142
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2024
Certificate Expiration Date 5/8/2026
Facility Type Physician Office
Lab Director EDWARD A. DIPRETA

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