11D1084851 CLIA NUMBER - SOUTH HENRY DIALYSIS LLC

Laboratory Demographics

  • CLIA Code: 11D1084851
  • Facility Name: SOUTH HENRY DIALYSIS LLC
  • Facility Address: 1095 HENRY PARKWAY CONNECTOR
    MCDONOUGH, GA
    ZIP 30253
  • Facility Phone: 678 565-6228
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MOHAMAD M. KASSEM
  • NPI Number: 1235317454
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1084851
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name SOUTH HENRY DIALYSIS LLC
Street 1095 HENRY PARKWAY CONNECTOR
City MCDONOUGH
State GA
ZIP 30253
Phone 678 565-6228
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MOHAMAD M. KASSEM

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