44D1076146 CLIA NUMBER - MEMPHIS SOUTHEAST DIALYSIS

Laboratory Demographics

  • CLIA Code: 44D1076146
  • Facility Name: MEMPHIS SOUTHEAST DIALYSIS
  • Facility Address: 1805 MORIAH WOODS BLVD SUITE #1
    MEMPHIS, TN
    ZIP 38117
  • Facility Phone: 901 850-0165
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JOBBY J. KELLEY MD
  • NPI Number: 1699961680
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D1076146
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MEMPHIS SOUTHEAST DIALYSIS
Street 1805 MORIAH WOODS BLVD SUITE #1
City MEMPHIS
State TN
ZIP 38117
Phone 901 850-0165
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JOBBY J. KELLEY MD

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