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11D2078046 CLIA NUMBER - MEDICAL DERMATOLOGY SPECIALISTS, PC

Laboratory Demographics

CLIA Number: 11D2078046

Facility Name: MEDICAL DERMATOLOGY SPECIALISTS, PC

Facility Address:
5730 GLENRIDGE DR SUITE T-100
ATLANTA, GA
ZIP 30328
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Facility Phone Number: 404 939-9220

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134544679

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name Field Value
CLIA Number 11D2078046
LAB Type Physician Office
Facility Name MEDICAL DERMATOLOGY SPECIALISTS, PC
Street 5730 GLENRIDGE DR SUITE T-100
City ATLANTA
State GA
ZIP 30328
Phone 404 939-9220
CertificateType 4
CertificateEffectiveDate 5/21/2022
CertificateExpirationDate 5/20/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024