25D0906493 CLIA NUMBER - GULF COAST DERMATOLOGY PA

Laboratory Demographics

  • CLIA Code: 25D0906493
  • Facility Name: GULF COAST DERMATOLOGY PA
  • Facility Address: 1304 44TH AVENUE
    GULFPORT, MS
    ZIP 39501
  • Facility Phone: 228 868-4006
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GWENDOLYN A. CRANE
  • NPI Number: 1376532788
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 25D0906493
LAB Type Physician Office
Facility Name GULF COAST DERMATOLOGY PA
Street 1304 44TH AVENUE
City GULFPORT
State MS
ZIP 39501
Phone 228 868-4006
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Physician Office
Lab Director GWENDOLYN A. CRANE

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