11D0646167 CLIA NUMBER - CAMILLA DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D0646167
  • Facility Name: CAMILLA DIALYSIS
  • Facility Address: 251 US HWY 19 NORTH
    CAMILLA, GA
    ZIP 31730
  • Facility Phone: 229 336-5874
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DARYL O. CRENSHAW
  • NPI Number: 1902317407
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0646167
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CAMILLA DIALYSIS
Street 251 US HWY 19 NORTH
City CAMILLA
State GA
ZIP 31730
Phone 229 336-5874
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DARYL O. CRENSHAW

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