11D0915857 CLIA NUMBER - SOUTHWEST ATLANTA NEPHROLOGY INC

Laboratory Demographics

CLIA Number: 11D0915857

Facility Name: SOUTHWEST ATLANTA NEPHROLOGY INC

Facility Address:
3620 MLK JR DRIVE SW
ATLANTA, GA
ZIP 30331
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Facility Phone Number: 404 696-7300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992756894

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	11D0915857
LAB Type	Physician Office
Facility Name	SOUTHWEST ATLANTA NEPHROLOGY INC
Street	3620 MLK JR DRIVE SW
City	ATLANTA
State	GA
ZIP	30331
Phone	404 696-7300
CertificateType	4
CertificateEffectiveDate	8/6/2023
CertificateExpirationDate	8/5/2025
FacilityType	Waiver

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