11D2311654 CLIA NUMBER - EXPERIENCE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 11D2311654
  • Facility Name: EXPERIENCE DERMATOLOGY
  • Facility Address: 17 EXECUTIVE PARK DRIVE, SUITE 115
    ATLANTA, GA
    ZIP 30329
  • Facility Phone: 404 737-2333
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ZACHARY W. EYRE
  • NPI Number: 1659115145
  • Taxonomy: 207N00000X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2311654
LAB Type Physician Office
Facility Name EXPERIENCE DERMATOLOGY
Street 17 EXECUTIVE PARK DRIVE, SUITE 115
City ATLANTA
State GA
ZIP 30329
Phone 404 737-2333
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 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director ZACHARY W. EYRE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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