11D0897879 CLIA NUMBER - EAST MACON DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 11D0897879

Facility Name: EAST MACON DIALYSIS CENTER

Facility Address:
165 EMERY HIGHWAY SUITE 101
MACON, GA
ZIP 31217
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Facility Phone Number: 912 755-1144

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073582425

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0897879
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EAST MACON DIALYSIS CENTER
Street	165 EMERY HIGHWAY SUITE 101
City	MACON
State	GA
ZIP	31217
Phone	912 755-1144
CertificateType	4
CertificateEffectiveDate	2/17/2023
CertificateExpirationDate	2/16/2025
FacilityType	Waiver

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