44D2121838 CLIA NUMBER - FORT CAMPBELL DIALYSIS

Laboratory Demographics

  • CLIA Code: 44D2121838
  • Facility Name: FORT CAMPBELL DIALYSIS
  • Facility Address: 1459 FORT CAMPBELL BLVD
    CLARKSVILLE, TN
    ZIP 37042
  • Facility Phone: 931 552-6491
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MOHAMMAD MOURAD
  • NPI Number: 1265983639
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 44D2121838
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name FORT CAMPBELL DIALYSIS
Street 1459 FORT CAMPBELL BLVD
City CLARKSVILLE
State TN
ZIP 37042
Phone 931 552-6491
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MOHAMMAD MOURAD

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