11D2179736 CLIA NUMBER - GRAYSON DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2179736
  • Facility Name: GRAYSON DIALYSIS
  • Facility Address: 4555 ATLANTA HIGHWAY, SUITE M
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 770 466-2582
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DILINI DASWATTA
  • NPI Number: 1659915882
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2179736
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GRAYSON DIALYSIS
Street 4555 ATLANTA HIGHWAY, SUITE M
City LOGANVILLE
State GA
ZIP 30052
Phone 770 466-2582
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DILINI DASWATTA

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