34D0240587 CLIA NUMBER - SOUTHERN DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 34D0240587
  • Facility Name: SOUTHERN DERMATOLOGY
  • Facility Address: 4201 LAKE BOONE TRAIL, SUITE 200
    RALEIGH, NC
    ZIP 27607
  • Facility Phone: 919 782-2152
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GREGORY WILMOTH
  • NPI Number: 1568415586
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 34D0240587
LAB Type Physician Office
Facility Name SOUTHERN DERMATOLOGY
Street 4201 LAKE BOONE TRAIL, SUITE 200
City RALEIGH
State NC
ZIP 27607
Phone 919 782-2152
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 6/2/2025
Certificate Expiration Date 6/1/2027
Facility Type Physician Office
Lab Director GREGORY WILMOTH

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