11D2022318 CLIA NUMBER - THACKER DERMATOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 11D2022318
  • Facility Name: THACKER DERMATOLOGY, LLC
  • Facility Address: 4233 CAMELOT CROSSING
    VALDOSTA, GA
    ZIP 31602
  • Facility Phone: 229 469-4383
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BETSY P. BACKE
  • NPI Number: 1326347238
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 11D2022318
LAB Type Physician Office
Facility Name THACKER DERMATOLOGY, LLC
Street 4233 CAMELOT CROSSING
City VALDOSTA
State GA
ZIP 31602
Phone 229 469-4383
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/12/2024
Certificate Expiration Date 10/11/2026
Facility Type Physician Office
Lab Director BETSY P. BACKE

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