11D0941077 CLIA NUMBER - GREENSBORO DIALYSIS

Laboratory Demographics

CLIA Number: 11D0941077

Facility Name: GREENSBORO DIALYSIS

Facility Address:
1041 WILLOW RUN ROAD
GREENSBORO, GA
ZIP 30642
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Facility Phone Number: 706 453-7222

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1265420327

Taxonomy: 261QE0700X - Clinic/Center

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	706 453-7222
CertificateType	4
CertificateEffectiveDate	2/11/2024
CertificateExpirationDate	2/10/2026
FacilityType	Waiver

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