11D2143136 CLIA NUMBER - PUTNAM DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 11D2143136
  • Facility Name: PUTNAM DIALYSIS CENTER
  • Facility Address: 301 SOUTH JEFFERSON AVENUE, SUITE 101
    EATONTON, GA
    ZIP 31024
  • Facility Phone: 706 485-1724
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MUFID A. OTHMAN
  • NPI Number: 1952819419
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2143136
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PUTNAM DIALYSIS CENTER
Street 301 SOUTH JEFFERSON AVENUE, SUITE 101
City EATONTON
State GA
ZIP 31024
Phone 706 485-1724
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2024
Certificate Expiration Date 1/24/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MUFID A. OTHMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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