11D1017535 CLIA NUMBER - NORTHWEST NEPHROLOGY CLINIC

Laboratory Demographics

  • CLIA Code: 11D1017535
  • Facility Name: NORTHWEST NEPHROLOGY CLINIC
  • Facility Address: 2711 IRVIN WAY SUITE 203
    DECATUR, GA
    ZIP 30030
  • Facility Phone: (770) 981-2211
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUAN L. PIMENTEL
  • NPI Number: 1215052261
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 11D1017535
LAB Type Physician Office
Facility Name NORTHWEST NEPHROLOGY CLINIC
Street 2711 IRVIN WAY SUITE 203
City DECATUR
State GA
ZIP 30030
Phone 7709812211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Physician Office
Lab Director JUAN L. PIMENTEL

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This page was last updated on: 5/18/2026