11D1106704 CLIA NUMBER - DSI MACON, LLC D/B/A/ US RENAL CARE MILLEDGEVILLE DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D1106704
  • Facility Name: DSI MACON, LLC D/B/A/ US RENAL CARE MILLEDGEVILLE DIALYSIS
  • Facility Address: 411 NORTH JEFFERSON STREET, NE
    MILLEDGEVILLE, GA
    ZIP 31061
  • Facility Phone: 478 453-0964
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: IHAB ZAGGOUT
  • NPI Number: 1295122679
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D1106704
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DSI MACON, LLC D/B/A/ US RENAL CARE MILLEDGEVILLE DIALYSIS
Street 411 NORTH JEFFERSON STREET, NE
City MILLEDGEVILLE
State GA
ZIP 31061
Phone 478 453-0964
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2025
Certificate Expiration Date 10/20/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director IHAB ZAGGOUT

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