11D2108169 CLIA NUMBER - FRESENIUS MEDICAL CARE POWDER SPRINGS

Laboratory Demographics

CLIA Number: 11D2108169

Facility Name: FRESENIUS MEDICAL CARE POWDER SPRINGS

Facility Address:
3602 MARATHON CIRCLE
AUSTELL, GA
ZIP 30106
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Facility Phone Number: 770 428-3538

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1881706695

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2108169
LAB Type	Physician Office
Facility Name	FRESENIUS MEDICAL CARE POWDER SPRINGS
Street	3602 MARATHON CIRCLE
City	AUSTELL
State	GA
ZIP	30106
Phone	770 428-3538
CertificateType	4
CertificateEffectiveDate	1/29/2024
CertificateExpirationDate	1/28/2026
FacilityType	Waiver

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