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11D2237646 CLIA NUMBER - SOUTHERN DERMATOLOGY MEDICAL LLC

Laboratory Demographics

CLIA Number: 11D2237646

Facility Name: SOUTHERN DERMATOLOGY MEDICAL LLC

Facility Address:
4150 WASHINGTON ROAD SUITE 6
EVANS, GA
ZIP 30809
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Facility Phone Number: 762 233-0019

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1699330985

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 11D2237646
LAB Type Physician Office
Facility Name SOUTHERN DERMATOLOGY MEDICAL LLC
Street 4150 WASHINGTON ROAD SUITE 6
City EVANS
State GA
ZIP 30809
Phone 762 233-0019
CertificateType 4
CertificateEffectiveDate 9/27/2023
CertificateExpirationDate 9/26/2025
FacilityType Waiver

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