11D2171778 CLIA NUMBER - QUAIL CITY HOME DIALYSIS

Laboratory Demographics

  • CLIA Code: 11D2171778
  • Facility Name: QUAIL CITY HOME DIALYSIS
  • Facility Address: 14661 US HIGHWAY 19 S
    THOMASVILLE, GA
    ZIP 31792
  • Facility Phone: 615 320-4283
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: RAUL G. SANTOS
  • NPI Number: 1588217673
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2171778
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name QUAIL CITY HOME DIALYSIS
Street 14661 US HIGHWAY 19 S
City THOMASVILLE
State GA
ZIP 31792
Phone 615 320-4283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2025
Certificate Expiration Date 9/9/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director RAUL G. SANTOS

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