11D1100178 CLIA NUMBER - GEORGIA DIALYSIS FOR ADOLESCENTS AND PEDIATRICS

Laboratory Demographics

  • CLIA Code: 11D1100178
  • Facility Name: GEORGIA DIALYSIS FOR ADOLESCENTS AND PEDIATRICS
  • Facility Address: 4434 HUGH HOWELL ROAD
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 491-7187
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. STEPHANIE JERNIGAN
  • NPI Number: 1992941736
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D1100178
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GEORGIA DIALYSIS FOR ADOLESCENTS AND PEDIATRICS
Street 4434 HUGH HOWELL ROAD
City TUCKER
State GA
ZIP 30084
Phone 770 491-7187
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 DR. STEPHANIE JERNIGAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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