11D2059139 CLIA NUMBER - OLD NATIONAL DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2059139
  • Facility Name: OLD NATIONAL DIALYSIS
  • Facility Address: 5615 OLD NATIONAL HIGHWAY, SUITE A
    COLLEGE PARK, GA
    ZIP 30349
  • Facility Phone: 404 762-9243
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. EDREA JONES
  • NPI Number: 1689915621
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2059139
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name OLD NATIONAL DIALYSIS
Street 5615 OLD NATIONAL HIGHWAY, SUITE A
City COLLEGE PARK
State GA
ZIP 30349
Phone 404 762-9243
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2025
Certificate Expiration Date 5/19/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. EDREA JONES

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