11D2148284 CLIA NUMBER - SUPER DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 11D2148284
  • Facility Name: SUPER DERMATOLOGY
  • Facility Address: 343 SALEM GATE DRIVE, SUITE 100
    CONYERS, GA
    ZIP 30013
  • Facility Phone: 770 285-3533
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DIONE M. SUPER
  • NPI Number: 1669971776
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 11D2148284
LAB Type Physician Office
Facility Name SUPER DERMATOLOGY
Street 343 SALEM GATE DRIVE, SUITE 100
City CONYERS
State GA
ZIP 30013
Phone 770 285-3533
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Physician Office
Lab Director DR. DIONE M. SUPER

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