11D2081319 CLIA NUMBER - FOREFRONT DERMATOLOGY, SC DBA ATLANTIC SHORE DERMATOLOGY, A FOREFRONT DERMATOLOGY PRACTICE

Laboratory Demographics

  • CLIA Code: 11D2081319
  • Facility Name: FOREFRONT DERMATOLOGY, SC DBA ATLANTIC SHORE DERMATOLOGY, A FOREFRONT DERMATOLOGY PRACTICE
  • Facility Address: 400 LISTER STREET
    WAYCROSS, GA
    ZIP 31501
  • Facility Phone: 912 283-4850
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ASHLEY C. CAVALIER
  • NPI Number: 1154938579
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 11D2081319
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, SC DBA ATLANTIC SHORE DERMATOLOGY, A FOREFRONT DERMATOLOGY PRACTICE
Street 400 LISTER STREET
City WAYCROSS
State GA
ZIP 31501
Phone 912 283-4850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Physician Office
Lab Director ASHLEY C. CAVALIER

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