11D2124236 CLIA NUMBER - TARA BOULEVARD DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2124236
  • Facility Name: TARA BOULEVARD DIALYSIS
  • Facility Address: 6540 TARA BLVD, SUITE 200
    JONESBORO, GA
    ZIP 30236
  • Facility Phone: 770 968-8429
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SABA KHAN
  • NPI Number: 1962946350
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2124236
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name TARA BOULEVARD DIALYSIS
Street 6540 TARA BLVD, SUITE 200
City JONESBORO
State GA
ZIP 30236
Phone 770 968-8429
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2025
Certificate Expiration Date 1/11/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SABA KHAN

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