11D1092305 CLIA NUMBER - KIDNEY DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 11D1092305
  • Facility Name: KIDNEY DIALYSIS CENTER
  • Facility Address: 640 MARTIN LUTHER KING JR BLVD, SUITE 100
    MACON, GA
    ZIP 31201
  • Facility Phone: (478) 742-5850
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: LUDWIG CAVALIERE
  • NPI Number: 1548429822
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1092305
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name KIDNEY DIALYSIS CENTER
Street 640 MARTIN LUTHER KING JR BLVD, SUITE 100
City MACON
State GA
ZIP 31201
Phone 4787425850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2024
Certificate Expiration Date 11/20/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director LUDWIG CAVALIERE

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This page was last updated on: 5/18/2026