11D2074765 CLIA NUMBER - ATHENS RENAL CENTER, LLC

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Laboratory Demographics

CLIA Number: 11D2074765

Facility Name: ATHENS RENAL CENTER, LLC

Facility Address:
2047 PRINCE AVENUE, SUITE A
ATHENS, GA
ZIP 30606
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Facility Phone Number: 706 549-2133

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1912320631

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2074765
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ATHENS RENAL CENTER, LLC
Street	2047 PRINCE AVENUE, SUITE A
City	ATHENS
State	GA
ZIP	30606
Phone	706 549-2133
CertificateType	4
CertificateEffectiveDate	3/17/2024
CertificateExpirationDate	3/16/2026
FacilityType	Waiver

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