11D2135914 CLIA NUMBER - MACON EASTSIDE DIALYSIS CENTER, LLC

Laboratory Demographics

  • CLIA Code: 11D2135914
  • Facility Name: MACON EASTSIDE DIALYSIS CENTER, LLC
  • Facility Address: 640 NORTH AVENUE, SUITE H
    MACON, GA
    ZIP 31211
  • Facility Phone: 478 621-0542
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SAGAR M. PANSE
  • NPI Number: 1699298794
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2135914
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MACON EASTSIDE DIALYSIS CENTER, LLC
Street 640 NORTH AVENUE, SUITE H
City MACON
State GA
ZIP 31211
Phone 478 621-0542
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SAGAR M. PANSE

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