11D2149809 CLIA NUMBER - COWAN LAKE DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2149809
  • Facility Name: COWAN LAKE DIALYSIS
  • Facility Address: 1950 HONEY CREEK COMMONS, SE
    CONYERS, GA
    ZIP 30094
  • Facility Phone: 770 918-2563
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: YILIKAL KASSA
  • NPI Number: 1063916153
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2149809
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name COWAN LAKE DIALYSIS
Street 1950 HONEY CREEK COMMONS, SE
City CONYERS
State GA
ZIP 30094
Phone 770 918-2563
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director YILIKAL KASSA

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