11D2190542 CLIA NUMBER - WEST CLAYTON DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2190542
  • Facility Name: WEST CLAYTON DIALYSIS
  • Facility Address: 100 PROMENADE PKWY, SUITE C
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 678 788-6328
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KHAN MUHAMMAD
  • NPI Number: 1336759463
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2190542
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name WEST CLAYTON DIALYSIS
Street 100 PROMENADE PKWY, SUITE C
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 788-6328
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2024
Certificate Expiration Date 8/16/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KHAN MUHAMMAD

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