11D2041542 CLIA NUMBER - EVANS DERMATOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 11D2041542
  • Facility Name: EVANS DERMATOLOGY, LLC
  • Facility Address: 1002 WILLIAMSBURG WAY
    EVANS, GA
    ZIP 30809
  • Facility Phone: 706 922-3376
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FRANCES T. FLORENTINO
  • NPI Number: 1083862577
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D2041542
LAB Type Physician Office
Facility Name EVANS DERMATOLOGY, LLC
Street 1002 WILLIAMSBURG WAY
City EVANS
State GA
ZIP 30809
Phone 706 922-3376
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2024
Certificate Expiration Date 5/23/2026
Facility Type Physician Office
Lab Director FRANCES T. FLORENTINO

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