Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 852592 (X3) Date Survey Completed 07/16/2025
Name of Provider or Supplier Kidneyspa East Atlanta Dialysis, Llc Street Address, City, State 2375 Metropolitan Pkwy Sw, Atlanta, GA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
V0000 An unannounced onsite survey to investigate Complaint # GA00255800 and # GA00255540, was conducted on July 16, 2025 and ended on July 16, 2025. Two of two allegations were substantiated. The following standard level deficiencies were cited: