11D0676371 CLIA NUMBER - EASTLAKE DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D0676371
  • Facility Name: EASTLAKE DIALYSIS
  • Facility Address: 1757 CANDLER ROAD
    DECATUR, GA
    ZIP 30032
  • Facility Phone: 404 289-2313
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KHALID IGBAL
  • NPI Number: 1447229422
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0676371
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name EASTLAKE DIALYSIS
Street 1757 CANDLER ROAD
City DECATUR
State GA
ZIP 30032
Phone 404 289-2313
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KHALID IGBAL

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This page was last updated on: 6/4/2025