11D2175881 CLIA NUMBER - GEORGIA DERMATOLOGY & SKIN CANCER CTR, LLC

Laboratory Demographics

  • CLIA Code: 11D2175881
  • Facility Name: GEORGIA DERMATOLOGY & SKIN CANCER CTR, LLC
  • Facility Address: 415 EAST CROSSVILLE ROAD
    ROSWELL, GA
    ZIP 30075
  • Facility Phone: 770 642-4644
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JASON ARNOLD
  • NPI Number: 1982773826
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 11D2175881
LAB Type Physician Office
Facility Name GEORGIA DERMATOLOGY & SKIN CANCER CTR, LLC
Street 415 EAST CROSSVILLE ROAD
City ROSWELL
State GA
ZIP 30075
Phone 770 642-4644
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 12/4/2023
Certificate Expiration Date 12/3/2025
Facility Type Physician Office
Lab Director JASON ARNOLD

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