11D0993809 CLIA NUMBER - USRC COVINGTON, LLC

Laboratory Demographics

CLIA Number: 11D0993809

Facility Name: USRC COVINGTON, LLC

Facility Address:
4179 BAKER STREET, NE
COVINGTON, GA
ZIP 30014
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Facility Phone Number: 770 385-4015

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184154148

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0993809
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USRC COVINGTON, LLC
Street	4179 BAKER STREET, NE
City	COVINGTON
State	GA
ZIP	30014
Phone	770 385-4015
CertificateType	4
CertificateEffectiveDate	11/27/2023
CertificateExpirationDate	11/26/2025
FacilityType	Waiver

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