11D0921008 CLIA NUMBER - NORTH GEORGIA KIDNEY SPECIALISTS

Laboratory Demographics

  • CLIA Code: 11D0921008
  • Facility Name: NORTH GEORGIA KIDNEY SPECIALISTS
  • Facility Address: 880 CANTON ROAD, SUITE 400
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 770 928-8991
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANOLO GALLEGO
  • NPI Number: 1134217342
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D0921008
LAB Type Physician Office
Facility Name NORTH GEORGIA KIDNEY SPECIALISTS
Street 880 CANTON ROAD, SUITE 400
City MARIETTA
State GA
ZIP 30060
Phone 770 928-8991
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2024
Certificate Expiration Date 10/16/2026
Facility Type Physician Office
Lab Director MANOLO GALLEGO

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