11D1069067 CLIA NUMBER - HYPERTENSION AND KIDNEY ASSOCIATES OF MIDDLE GEORGIA

Laboratory Demographics

CLIA Number: 11D1069067

Facility Name: HYPERTENSION AND KIDNEY ASSOCIATES OF MIDDLE GEORGIA

Facility Address:
105 TOMMY STALNAKER DRIVE, SUITE 1
WARNER ROBINS, GA
ZIP 31088
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Facility Phone Number: 478 333-3612

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1508061151

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	11D1069067
LAB Type	Physician Office
Facility Name	HYPERTENSION AND KIDNEY ASSOCIATES OF MIDDLE GEORGIA
Street	105 TOMMY STALNAKER DRIVE, SUITE 1
City	WARNER ROBINS
State	GA
ZIP	31088
Phone	478 333-3612
CertificateType	4
CertificateEffectiveDate	6/18/2022
CertificateExpirationDate	6/17/2024
FacilityType	Waiver

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