11D1062045 CLIA NUMBER - MOUNTAIN PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D1062045
  • Facility Name: MOUNTAIN PARK DIALYSIS
  • Facility Address: 5235 MEMORIAL DRIVE
    STONE MOUNTAIN, GA
    ZIP 30083
  • Facility Phone: 404 296-1344
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DWARAKINATH HARISH
  • NPI Number: 1093808834
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1062045
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MOUNTAIN PARK DIALYSIS
Street 5235 MEMORIAL DRIVE
City STONE MOUNTAIN
State GA
ZIP 30083
Phone 404 296-1344
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2024
Certificate Expiration Date 12/4/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DWARAKINATH HARISH

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