11D2308465 CLIA NUMBER - GEORGIA KIDNEY CARE

Laboratory Demographics

  • CLIA Code: 11D2308465
  • Facility Name: GEORGIA KIDNEY CARE
  • Facility Address: 1000 COWLES CLINIC WAY CYPRESS COTTAGE, SUITE CY-300
    GREENSBORO, GA
    ZIP 30642
  • Facility Phone: 706 410-2111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUAN PIMENTEL
  • NPI Number: 1114768132
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2308465
LAB Type Physician Office
Facility Name GEORGIA KIDNEY CARE
Street 1000 COWLES CLINIC WAY CYPRESS COTTAGE, SUITE CY-300
City GREENSBORO
State GA
ZIP 30642
Phone 706 410-2111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2024
Certificate Expiration Date 7/29/2026
Facility Type Physician Office
Lab Director JUAN PIMENTEL

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