11D1041565 CLIA NUMBER - GEORGIA RENAL SPECIALISTS, LLC

Laboratory Demographics

  • CLIA Code: 11D1041565
  • Facility Name: GEORGIA RENAL SPECIALISTS, LLC
  • Facility Address: 105 COLLIER ROAD NW SUITE 1040
    ATLANTA, GA
    ZIP 30309
  • Facility Phone: 404 352-8522
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RODERIC L. WOODSON
  • NPI Number: 1376917062
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 11D1041565
LAB Type Physician Office
Facility Name GEORGIA RENAL SPECIALISTS, LLC
Street 105 COLLIER ROAD NW SUITE 1040
City ATLANTA
State GA
ZIP 30309
Phone 404 352-8522
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Physician Office
Lab Director DR. RODERIC L. WOODSON

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This page was last updated on: 9/29/2025