11D1017785 CLIA NUMBER - GEORGIA KIDNEY ASSOCIATES

Laboratory Demographics

  • CLIA Code: 11D1017785
  • Facility Name: GEORGIA KIDNEY ASSOCIATES
  • Facility Address: 120 STONE BRIDGE PARKWAY SUITE 410
    WOODSTOCK, GA
    ZIP 30189
  • Facility Phone: 770 427-7389
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROBERT D. JANSEN
  • NPI Number: 1215476304
  • Taxonomy: 363LA2100X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D1017785
LAB Type Physician Office
Facility Name GEORGIA KIDNEY ASSOCIATES
Street 120 STONE BRIDGE PARKWAY SUITE 410
City WOODSTOCK
State GA
ZIP 30189
Phone 770 427-7389
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 10/6/2023
Certificate Expiration Date 10/5/2025
Facility Type Physician Office
Lab Director ROBERT D. JANSEN

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