11D0997272 CLIA NUMBER - ARA AUGUSTA CLINIC LLC DBA NCA AUGUSTA

Laboratory Demographics

CLIA Number: 11D0997272

Facility Name: ARA AUGUSTA CLINIC LLC DBA NCA AUGUSTA

Facility Address:
1000 TELFAIR STREET
AUGUSTA, GA
ZIP 30901
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Facility Phone Number: 706 774-0130

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1194772947

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D0997272
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ARA AUGUSTA CLINIC LLC DBA NCA AUGUSTA
Street	1000 TELFAIR STREET
City	AUGUSTA
State	GA
ZIP	30901
Phone	706 774-0130
CertificateType	4
CertificateEffectiveDate	3/12/2024
CertificateExpirationDate	3/11/2026
FacilityType	Waiver

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