11D2107014 CLIA NUMBER - AQUA DERMATOLOGY OF GEORGIA, PC

Laboratory Demographics

  • CLIA Code: 11D2107014
  • Facility Name: AQUA DERMATOLOGY OF GEORGIA, PC
  • Facility Address: 1357 HEMBREE ROAD, SUITE 250
    ROSWELL, GA
    ZIP 30076
  • Facility Phone: 770 754-0787
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MARCUS B. GOODMAN
  • NPI Number: 1770801144
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 11D2107014
LAB Type Physician Office
Facility Name AQUA DERMATOLOGY OF GEORGIA, PC
Street 1357 HEMBREE ROAD, SUITE 250
City ROSWELL
State GA
ZIP 30076
Phone 770 754-0787
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/13/2025
Certificate Expiration Date 9/12/2027
Facility Type Physician Office
Lab Director MARCUS B. GOODMAN

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