11D1099479 CLIA NUMBER - MADISON KIDNEY CENTER

Laboratory Demographics

CLIA Number: 11D1099479

Facility Name: MADISON KIDNEY CENTER

Facility Address:
1311 ATLANTA HIGHWAY SUITE A
MADISON, GA
ZIP 30650
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Facility Phone Number: 706 752-1113

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1871680264

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1099479
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MADISON KIDNEY CENTER
Street	1311 ATLANTA HIGHWAY SUITE A
City	MADISON
State	GA
ZIP	30650
Phone	706 752-1113
CertificateType	4
CertificateEffectiveDate	5/14/2023
CertificateExpirationDate	5/13/2025
FacilityType	Waiver

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