NPI age
14 years
Enumerated 2011-07-19
● Active Type 2 · Organization
Southeastern Dermatopathology, Llc
Southeastern Dermatopathology, Llc is 1 of 621 clinical medical laboratory organizations in Georgia.
Primary specialty
Clinical Medical Laboratory
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Bouldin
Laboratory Director
Last NPPES update
2011-07-19
Source: monthly bulk 2026-05
How this organization compares
Across 621 active clinical medical laboratory providers in Georgia.
NPI age
14 years
↑ 9 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2011 → 2026
2011-07Enumerated in NPPES
2011
2026
Where they practice
Primary practice location
1067 Windermere Xing
Cumming, GA 300416104
Mailing address
1067 Windermere Xing
Cumming, GA 300416104
Authorized official
Molly Bouldin, M.D.
Laboratory Director
📞 2059106852
Specialties
-
Clinical Medical Laboratory Primary(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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | ME81020 | MEDICAL LICENSE FLORIDA |
| 01 | 1174502827 | NPI TYPE 1 |
| 01 | 47704 | MEDICAL LICENSE GA |
Practice context
Single-site organization. Only one practice location on file.
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