11D2220386 CLIA NUMBER - KIDNEY CLINIC CORDELE LLC

Laboratory Demographics

  • CLIA Code: 11D2220386
  • Facility Name: KIDNEY CLINIC CORDELE LLC
  • Facility Address: 106 WEST 4TH AVENUE
    CORDELE, GA
    ZIP 31015
  • Facility Phone: 229 276-3541
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDRE D. FERIA
  • NPI Number: 1336726215
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2220386
LAB Type Physician Office
Facility Name KIDNEY CLINIC CORDELE LLC
Street 106 WEST 4TH AVENUE
City CORDELE
State GA
ZIP 31015
Phone 229 276-3541
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Physician Office
Lab Director ANDRE D. FERIA

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