11D0941077 CLIA NUMBER - GREENSBORO DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D0941077
  • Facility Name: GREENSBORO DIALYSIS
  • Facility Address: 1041 WILLOW RUN ROAD
    GREENSBORO, GA
    ZIP 30642
  • Facility Phone: (706) 453-7222
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. GAUTAM DAS GUPTA
  • NPI Number: 1265420327
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0941077
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GREENSBORO DIALYSIS
Street 1041 WILLOW RUN ROAD
City GREENSBORO
State GA
ZIP 30642
Phone 7064537222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2026
Certificate Expiration Date 2/10/2028
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. GAUTAM DAS GUPTA

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This page was last updated on: 6/29/2026