SOUTHEASTERN DERMATOPATHOLOGY, LLC
NPI 1932497492
Clinical Medical Laboratory in Cumming, GA

Active since July 19, 2011CLIA 11D2025057 · Certificate of Compliance
1067 WINDERMERE XING, CUMMING, GA 30041(205) 910-6852 Get Directions Write a Review

NPPES record last updated: July 19, 2011. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Southeastern Dermatopathology, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEASTERN DERMATOPATHOLOGY, LLC (NPI 1932497492) is a healthcare organization registered as a clinical medical laboratory in Cumming, Georgia and active in the NPI registry since July 2011. The organization holds a CLIA Certificate of Compliance certificate valid through September 28, 2027 and lists Molly Bouldin, Laboratory Director, as its authorized official.

NPPES Registry Identity

NPI1932497492
Entity TypeOrganization
Primary Taxonomy291U00000X
Legal Business NameSOUTHEASTERN DERMATOPATHOLOGY, LLC
Location Address1067 WINDERMERE XINGCumming, GA 30041-6104
Mailing Address1067 Windermere XingCumming, GA 30041-6104 · (205) 910-6852
Organization SubpartNo
Authorized OfficialMolly BouldinLaboratory Director · (205) 910-6852
Enumeration DateJuly 19, 2011
NPI 1932497492 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinical Medical LaboratoryLaboratories
Taxonomy Code291U00000X
License Licensed in GA · 47704
Definition

(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.

1067 WINDERMERE XING, Cumming, GA 30041

Other Identifiers 4

Medicare UPING99565
Other1174502827Npi Type 1
OtherME81020Medical License Florida
Other47704Medical License Ga

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 11D2025057

Southeastern Dermatopathology, LLC · Cumming, GA
Active · expires Sep 28, 2027
CLIA Number11D2025057
Laboratory TypeIndependent
Certificate Effective DateSeptember 29, 2025
Certificate Expiration DateSeptember 28, 2027
Laboratory DirectorMolly B. Bouldin
Laboratory Phone(205) 910-6852
Laboratory LocationSoutheastern Dermatopathology, LLC1067 Windermere Xing, Cumming, GA 30041
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeastern Dermatopathology, LLC's NPI number?

The NPI number for Southeastern Dermatopathology, LLC is 1932497492. It was assigned to this organization in the NPPES registry on July 19, 2011.

Where is Southeastern Dermatopathology, LLC located?

Southeastern Dermatopathology, LLC is located at 1067 Windermere Xing, Cumming, GA 30041. The listed phone number is (205) 910-6852.

What is Southeastern Dermatopathology, LLC's specialty?

The primary specialty registered for this NPI is Clinical Medical Laboratory with taxonomy code 291U00000X.

Does Southeastern Dermatopathology, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 11D2025057) is associated with this NPI, valid through September 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southeastern Dermatopathology, LLC was last updated on July 19, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.