11D2220542 CLIA NUMBER - JESUP HOME KIDNEY CARE

Laboratory Demographics

  • CLIA Code: 11D2220542
  • Facility Name: JESUP HOME KIDNEY CARE
  • Facility Address: 320 PEACHTREE STREET
    JESUP, GA
    ZIP 31545
  • Facility Phone: 912 521-8039
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: COLETTE LEE-LEWIS
  • NPI Number: 1578133674
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2220542
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JESUP HOME KIDNEY CARE
Street 320 PEACHTREE STREET
City JESUP
State GA
ZIP 31545
Phone 912 521-8039
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director COLETTE LEE-LEWIS

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