11D1100177 CLIA NUMBER - PEACHTREE CITY DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D1100177
  • Facility Name: PEACHTREE CITY DIALYSIS
  • Facility Address: 2832 W HIGHWAY 54 BLDG 100 SUITE J & K
    PEACHTREE CITY, GA
    ZIP 30269
  • Facility Phone: 678 364-9165
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DARIUSH BAHRAMI MD
  • NPI Number: 1518108489
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1100177
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PEACHTREE CITY DIALYSIS
Street 2832 W HIGHWAY 54 BLDG 100 SUITE J & K
City PEACHTREE CITY
State GA
ZIP 30269
Phone 678 364-9165
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2025
Certificate Expiration Date 5/31/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DARIUSH BAHRAMI MD

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