11D1004810 CLIA NUMBER - KIDNEY CLINIC

Laboratory Demographics

  • CLIA Code: 11D1004810
  • Facility Name: KIDNEY CLINIC
  • Facility Address: 1425 HIGHWAY 34 EAST
    NEWNAN, GA
    ZIP 30265
  • Facility Phone: 770 251-7896
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOELLEN JONES
  • NPI Number: 1083803472
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D1004810
LAB Type Physician Office
Facility Name KIDNEY CLINIC
Street 1425 HIGHWAY 34 EAST
City NEWNAN
State GA
ZIP 30265
Phone 770 251-7896
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/7/2024
Certificate Expiration Date 10/6/2026
Facility Type Physician Office
Lab Director JOELLEN JONES

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This page was last updated on: 3/20/2025