11D1048130 CLIA NUMBER - FMS LAWRENCEVILLE, LLC

Laboratory Demographics

CLIA Number: 11D1048130

Facility Name: FMS LAWRENCEVILLE, LLC

Facility Address:
1115 HERRINGTON ROAD
LAWRENCEVILLE, GA
ZIP 30044
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Facility Phone Number: 770 935-3546

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1689928020

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1048130
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FMS LAWRENCEVILLE, LLC
Street	1115 HERRINGTON ROAD
City	LAWRENCEVILLE
State	GA
ZIP	30044
Phone	770 935-3546
CertificateType	4
CertificateEffectiveDate	11/22/2023
CertificateExpirationDate	11/21/2025
FacilityType	Waiver

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