11D1099652 CLIA NUMBER - FRESENIUS MEDICAL CARE CROSSROADS

Laboratory Demographics

CLIA Number: 11D1099652

Facility Name: FRESENIUS MEDICAL CARE CROSSROADS

Facility Address:
1719 MAGNOLIA WAY
AUGUSTA, GA
ZIP 30909
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Facility Phone Number: 706 228-7253

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1235370164

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	11D1099652
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE CROSSROADS
Street	1719 MAGNOLIA WAY
City	AUGUSTA
State	GA
ZIP	30909
Phone	706 228-7253
CertificateType	4
CertificateEffectiveDate	5/19/2023
CertificateExpirationDate	5/18/2025
FacilityType	Waiver

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