11D2073783 CLIA NUMBER - INNOVATIVE HOME DIALYSIS OF GEORGIA, LLC DBA U S RENAL CARE GEORGIA HOME DIALYSIS

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Laboratory Demographics

CLIA Number: 11D2073783

Facility Name: INNOVATIVE HOME DIALYSIS OF GEORGIA, LLC DBA U S RENAL CARE GEORGIA HOME DIALYSIS

Facility Address:
3753 MARIETTA HIGHWAY, SUITE 100
CANTON, GA
ZIP 30114
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Facility Phone Number: 770 345-4103

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932522950

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2073783
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	INNOVATIVE HOME DIALYSIS OF GEORGIA, LLC DBA U S RENAL CARE GEORGIA HOME DIALYSIS
Street	3753 MARIETTA HIGHWAY, SUITE 100
City	CANTON
State	GA
ZIP	30114
Phone	770 345-4103
CertificateType	4
CertificateEffectiveDate	2/25/2024
CertificateExpirationDate	2/24/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024