11D1004865 CLIA NUMBER - NEWNAN DIALYSIS SERVICES

Laboratory Demographics

CLIA Number: 11D1004865

Facility Name: NEWNAN DIALYSIS SERVICES

Facility Address:
101 WERZ INDUSTRIAL DRIVE ATTN TERESA YOUNG, RN
NEWNAN, GA
ZIP 30263
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Facility Phone Number: 770 251-7896

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1194704957

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1004865
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NEWNAN DIALYSIS SERVICES
Street	101 WERZ INDUSTRIAL DRIVE ATTN TERESA YOUNG, RN
City	NEWNAN
State	GA
ZIP	30263
Phone	770 251-7896
CertificateType	4
CertificateEffectiveDate	10/9/2022
CertificateExpirationDate	10/8/2024
FacilityType	Waiver

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