11D1066779 CLIA NUMBER - MEDLOCK BRIDGE DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D1066779
  • Facility Name: MEDLOCK BRIDGE DIALYSIS
  • Facility Address: 10680 MEDLOCK BRIDGE ROAD SUITE 103
    DULUTH, GA
    ZIP 30097
  • Facility Phone: 770 622-2167
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KAHIED NASS
  • NPI Number: 1386737112
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1066779
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MEDLOCK BRIDGE DIALYSIS
Street 10680 MEDLOCK BRIDGE ROAD SUITE 103
City DULUTH
State GA
ZIP 30097
Phone 770 622-2167
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KAHIED NASS

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