11D1081073 CLIA NUMBER - NRA LAGRANGE GEORGIA LLC DBA LAGRANGE DIALYSIS CLINIC

Laboratory Demographics

  • CLIA Code: 11D1081073
  • Facility Name: NRA LAGRANGE GEORGIA LLC DBA LAGRANGE DIALYSIS CLINIC
  • Facility Address: 140 OLD MILL ROAD
    LAGRANGE, GA
    ZIP 30241
  • Facility Phone: 706 884-6825
  • Facility Type: Blood Bank
  • Facility Type: Waiver
  • Lab Director: ANDRE D. FERIA MD
  • NPI Number: 1417134206
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1081073
LAB Type Blood Bank
Facility Name NRA LAGRANGE GEORGIA LLC DBA LAGRANGE DIALYSIS CLINIC
Street 140 OLD MILL ROAD
City LAGRANGE
State GA
ZIP 30241
Phone 706 884-6825
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2024
Certificate Expiration Date 3/9/2026
Facility Type Blood Bank
Lab Director ANDRE D. FERIA MD

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