11D1101210 CLIA NUMBER - CLASSIC CITY DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D1101210
  • Facility Name: CLASSIC CITY DIALYSIS
  • Facility Address: 1686 PRINCE AVENUE
    ATHENS, GA
    ZIP 30606
  • Facility Phone: 706 850-7400
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: EMAD U. AHMED
  • NPI Number: 1306336383
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1101210
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CLASSIC CITY DIALYSIS
Street 1686 PRINCE AVENUE
City ATHENS
State GA
ZIP 30606
Phone 706 850-7400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/23/2025
Certificate Expiration Date 6/22/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director EMAD U. AHMED

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