11D0926640 CLIA NUMBER - DIALYSIS CLINIC INC FAYETTEVILLE

Laboratory Demographics

  • CLIA Code: 11D0926640
  • Facility Name: DIALYSIS CLINIC INC FAYETTEVILLE
  • Facility Address: 155 BRANDYWINE BLVD
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 716-6940
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: RODERIC WOODSON
  • NPI Number: 1043243421
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0926640
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DIALYSIS CLINIC INC FAYETTEVILLE
Street 155 BRANDYWINE BLVD
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 716-6940
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2025
Certificate Expiration Date 3/26/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director RODERIC WOODSON

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