11D0900108 CLIA NUMBER - BRUNSWICK SOUTH DIALYSIS

Laboratory Demographics

CLIA Number: 11D0900108

Facility Name: BRUNSWICK SOUTH DIALYSIS

Facility Address:
2930 SPRINGDALE ROAD
BRUNSWICK, GA
ZIP 31520
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Facility Phone Number: 912 264-1507

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1922054410

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0900108
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BRUNSWICK SOUTH DIALYSIS
Street	2930 SPRINGDALE ROAD
City	BRUNSWICK
State	GA
ZIP	31520
Phone	912 264-1507
CertificateType	4
CertificateEffectiveDate	11/13/2023
CertificateExpirationDate	11/12/2025
FacilityType	Waiver

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