11D1075259 CLIA NUMBER - SOUTHSTAR ADAMSVILLE DIALYSIS

Laboratory Demographics

CLIA Number: 11D1075259

Facility Name: SOUTHSTAR ADAMSVILLE DIALYSIS

Facility Address:
3651 BAKERS FERRY ROAD SW
ATLANTA, GA
ZIP 30331
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Facility Phone Number: 404 472-1856

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1851594329

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1075259
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTHSTAR ADAMSVILLE DIALYSIS
Street	3651 BAKERS FERRY ROAD SW
City	ATLANTA
State	GA
ZIP	30331
Phone	404 472-1856
CertificateType	4
CertificateEffectiveDate	10/17/2023
CertificateExpirationDate	10/16/2025
FacilityType	Waiver

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