11D0668152 CLIA NUMBER - THOMASTON DIALYSIS

Laboratory Demographics

CLIA Number: 11D0668152

Facility Name: THOMASTON DIALYSIS

Facility Address:
1065 HIGHWAY 19N
THOMASTON, GA
ZIP 30286
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Facility Phone Number: 706 648-6364

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1568431484

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0668152
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	THOMASTON DIALYSIS
Street	1065 HIGHWAY 19N
City	THOMASTON
State	GA
ZIP	30286
Phone	706 648-6364
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024