11D2227842 CLIA NUMBER - TRIBBLE MILL DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2227842
  • Facility Name: TRIBBLE MILL DIALYSIS
  • Facility Address: 1719 NEW HOPE ROAD
    LAWRENCEVILLE, GA
    ZIP 30045
  • Facility Phone: 470 622-7112
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JAYANTI JASTI
  • NPI Number: 1629607098
  • Taxonomy: 261QE0700X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2025
Certificate Expiration Date 6/16/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JAYANTI JASTI

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