11D2188461 CLIA NUMBER - MOUNTAINSIDE DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2188461
  • Facility Name: MOUNTAINSIDE DIALYSIS
  • Facility Address: 700 N MAIN STREET
    JASPER, GA
    ZIP 30143
  • Facility Phone: 678 387-1274
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DENISH BHATIA
  • NPI Number: 1245869619
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2188461
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MOUNTAINSIDE DIALYSIS
Street 700 N MAIN STREET
City JASPER
State GA
ZIP 30143
Phone 678 387-1274
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2024
Certificate Expiration Date 7/16/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DENISH BHATIA

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