11D2107682 CLIA NUMBER - CHAPEL WOODS DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2107682
  • Facility Name: CHAPEL WOODS DIALYSIS
  • Facility Address: 2640 WESLEY CHAPEL RD, STE 25D
    DECATUR, GA
    ZIP 30034
  • Facility Phone: 770 987-1439
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: TANJELLA M. JACKSON
  • NPI Number: 1942672423
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2107682
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CHAPEL WOODS DIALYSIS
Street 2640 WESLEY CHAPEL RD, STE 25D
City DECATUR
State GA
ZIP 30034
Phone 770 987-1439
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director TANJELLA M. JACKSON

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This page was last updated on: 3/20/2025