11D0997271 CLIA NUMBER - VIDALIA FIRST STREET DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D0997271
  • Facility Name: VIDALIA FIRST STREET DIALYSIS
  • Facility Address: 906 EAST 1ST STREET
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 538-8908
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: COURAGE ATEKHA
  • NPI Number: 1720242779
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D0997271
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name VIDALIA FIRST STREET DIALYSIS
Street 906 EAST 1ST STREET
City VIDALIA
State GA
ZIP 30474
Phone 912 538-8908
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director COURAGE ATEKHA

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This page was last updated on: 9/29/2025