Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 852554 (X3) Date Survey Completed 07/26/2021
Name of Provider or Supplier Panola Dialysis Street Address, City, State 5360 Snapfinger Woods Dr, Ste 102, Stonecrest, GA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
V0000 An onsite survey to investigate Complaint #GA00215364 and COVID-19 Focused Infection Control survey was conducted on July 26, 2021. The survey revealed that the facility was in substantial compliance with 42-CFR Part 494, Conditions for Coverage for End Stage Renal Disease Facilities. The allegation was substantiated. The following deficiency was cited: