11D0965435 CLIA NUMBER - HOLTON DIALYSIS CLINIC

Laboratory Demographics

CLIA Number: 11D0965435

Facility Name: HOLTON DIALYSIS CLINIC

Facility Address:
231 NW 14TH STREET
ATLANTA, GA
ZIP 30318
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Facility Phone Number: 404 892-8554

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1730291550

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0965435
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	HOLTON DIALYSIS CLINIC
Street	231 NW 14TH STREET
City	ATLANTA
State	GA
ZIP	30318
Phone	404 892-8554
CertificateType	4
CertificateEffectiveDate	9/21/2023
CertificateExpirationDate	9/20/2025
FacilityType	Waiver

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