11D0891569 CLIA NUMBER - PAULDING DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D0891569
  • Facility Name: PAULDING DIALYSIS
  • Facility Address: 4019 JOHNS ROAD
    DALLAS, GA
    ZIP 30132
  • Facility Phone: 770 445-3571
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: NNAEMEZIE ODIOEMENE
  • NPI Number: 1073540506
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0891569
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PAULDING DIALYSIS
Street 4019 JOHNS ROAD
City DALLAS
State GA
ZIP 30132
Phone 770 445-3571
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director NNAEMEZIE ODIOEMENE

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