11D1098175 CLIA NUMBER - SATILLA RIVER DIALYSIS

Laboratory Demographics

CLIA Number: 11D1098175

Facility Name: SATILLA RIVER DIALYSIS

Facility Address:
308 CARSWELL AVENUE
WAYCROSS, GA
ZIP 31501
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Facility Phone Number: 912 285-1663

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1538392071

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1098175
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SATILLA RIVER DIALYSIS
Street	308 CARSWELL AVENUE
City	WAYCROSS
State	GA
ZIP	31501
Phone	912 285-1663
CertificateType	4
CertificateEffectiveDate	4/14/2023
CertificateExpirationDate	4/13/2025
FacilityType	Waiver

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