11D0947601 CLIA NUMBER - MCDONOUGH DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 11D0947601
  • Facility Name: MCDONOUGH DIALYSIS CENTER
  • Facility Address: 114 DUNN STREET
    MCDONOUGH, GA
    ZIP 30253
  • Facility Phone: 770 898-4999
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DEMETRIOUS BLACKMON
  • NPI Number: 1952370892
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0947601
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MCDONOUGH DIALYSIS CENTER
Street 114 DUNN STREET
City MCDONOUGH
State GA
ZIP 30253
Phone 770 898-4999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DEMETRIOUS BLACKMON

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