42D2079058 CLIA NUMBER - SEASIDE DERMATOLOGY, PA

Laboratory Demographics

  • CLIA Code: 42D2079058
  • Facility Name: SEASIDE DERMATOLOGY, PA
  • Facility Address: 4017 HWY 17, SUITE 200
    MURRELLS INLET, SC
    ZIP 29576
  • Facility Phone: 843 651-4600
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. VIENNA L. GIBSON
  • NPI Number: 1376969428
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 42D2079058
LAB Type Physician Office
Facility Name SEASIDE DERMATOLOGY, PA
Street 4017 HWY 17, SUITE 200
City MURRELLS INLET
State SC
ZIP 29576
Phone 843 651-4600
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 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director DR. VIENNA L. GIBSON

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