11D2227842 CLIA NUMBER - TRIBBLE MILL DIALYSIS

Laboratory Demographics

CLIA Number: 11D2227842

Facility Name: TRIBBLE MILL DIALYSIS

Facility Address:
1719 NEW HOPE ROAD
LAWRENCEVILLE, GA
ZIP 30045
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Facility Phone Number: 470 622-7112

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1629607098

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D2227842
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TRIBBLE MILL DIALYSIS
Street	1719 NEW HOPE ROAD
City	LAWRENCEVILLE
State	GA
ZIP	30045
Phone	470 622-7112
CertificateType	4
CertificateEffectiveDate	6/17/2023
CertificateExpirationDate	6/16/2025
FacilityType	Waiver

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