11D2144831 CLIA NUMBER - CARROLLTON DERMATOLOGY & SKIN CANCER ASSOCIATES

Laboratory Demographics

CLIA Number: 11D2144831

Facility Name: CARROLLTON DERMATOLOGY & SKIN CANCER ASSOCIATES

Facility Address:
410 DIXIE STREET
CARROLLTON, GA
ZIP 30117
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Facility Phone Number: 770 834-0818

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1699215541

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	11D2144831
LAB Type	Physician Office
Facility Name	CARROLLTON DERMATOLOGY & SKIN CANCER ASSOCIATES
Street	410 DIXIE STREET
City	CARROLLTON
State	GA
ZIP	30117
Phone	770 834-0818
CertificateType	2
CertificateEffectiveDate	1/17/2023
CertificateExpirationDate	1/16/2025
FacilityType	Compliance

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