25D0693217 CLIA NUMBER - CANTON RENAL CENTER

Laboratory Demographics

  • CLIA Code: 25D0693217
  • Facility Name: CANTON RENAL CENTER
  • Facility Address: 620 E PEACE ST
    CANTON, MS
    ZIP 39046
  • Facility Phone: 601 859-3382
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: GARY DAVIS
  • NPI Number: 1083669089
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0693217
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CANTON RENAL CENTER
Street 620 E PEACE ST
City CANTON
State MS
ZIP 39046
Phone 601 859-3382
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director GARY DAVIS

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