11D0908356 CLIA NUMBER - NORTH FULTON DIALYSIS

Laboratory Demographics

CLIA Number: 11D0908356

Facility Name: NORTH FULTON DIALYSIS

Facility Address:
1250 NORTH MEADOW PARKWAY SUITE 120
ROSWELL, GA
ZIP 30076
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Facility Phone Number: 770 569-2888

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1134197296

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0908356
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NORTH FULTON DIALYSIS
Street	1250 NORTH MEADOW PARKWAY SUITE 120
City	ROSWELL
State	GA
ZIP	30076
Phone	770 569-2888
CertificateType	4
CertificateEffectiveDate	11/3/2023
CertificateExpirationDate	11/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024