04D0304709 CLIA NUMBER - DOTHAN HYPERTENSION NEPHROLOGY ASSOC

Laboratory Demographics

  • CLIA Code: 04D0304709
  • Facility Name: DOTHAN HYPERTENSION NEPHROLOGY ASSOC
  • Facility Address: 207 HAVEN DRIVE
    DOTHAN, AL
    ZIP 36301
  • Facility Phone: 334 793-3319
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GANJUR H. GURU PRAKASH
  • NPI Number: 1013018407
  • Taxonomy: 174400000X - Specialist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D0304709
LAB Type Physician Office
Facility Name DOTHAN HYPERTENSION NEPHROLOGY ASSOC
Street 207 HAVEN DRIVE
City DOTHAN
State AL
ZIP 36301
Phone 334 793-3319
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/29/2023
Certificate Expiration Date 11/28/2025
Facility Type Physician Office
Lab Director GANJUR H. GURU PRAKASH

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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