11D2171340 CLIA NUMBER - CAMP CREEK DIALYSIS

Laboratory Demographics

CLIA Number: 11D2171340

Facility Name: CAMP CREEK DIALYSIS

Facility Address:
3030 HEADLAND DRIVE, SW, SUITE C
ATLANTA, GA
ZIP 30311
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Facility Phone Number: 404 349-6790

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1013562818

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2171340
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CAMP CREEK DIALYSIS
Street	3030 HEADLAND DRIVE, SW, SUITE C
City	ATLANTA
State	GA
ZIP	30311
Phone	404 349-6790
CertificateType	4
CertificateEffectiveDate	8/29/2023
CertificateExpirationDate	8/28/2025
FacilityType	Waiver

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