11D2142861 CLIA NUMBER - LILBURN DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2142861
  • Facility Name: LILBURN DIALYSIS
  • Facility Address: 4805 LAWRENCEVILLE HIGHWAY, SUITE 320 B
    LILBURN, GA
    ZIP 30047
  • Facility Phone: 770 381-7544
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DIVAKAR JAMMALAMADAKA
  • NPI Number: 1659898492
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2142861
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LILBURN DIALYSIS
Street 4805 LAWRENCEVILLE HIGHWAY, SUITE 320 B
City LILBURN
State GA
ZIP 30047
Phone 770 381-7544
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2024
Certificate Expiration Date 1/21/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DIVAKAR JAMMALAMADAKA

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