11D0960346 CLIA NUMBER - SOUTH AUGUSTA DIALYSIS CLINIC, LLC

Laboratory Demographics

CLIA Number: 11D0960346

Facility Name: SOUTH AUGUSTA DIALYSIS CLINIC, LLC

Facility Address:
2115 WINDSOR SPRING ROAD, SUITE 18
AUGUSTA, GA
ZIP 30906
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Facility Phone Number: 706 798-5774

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1356749212

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0960346
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTH AUGUSTA DIALYSIS CLINIC, LLC
Street	2115 WINDSOR SPRING ROAD, SUITE 18
City	AUGUSTA
State	GA
ZIP	30906
Phone	706 798-5774
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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