| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852567 | (X3) Date Survey Completed 05/17/2023 |
| Name of Provider or Supplier Fairburn Palmetto Dialysis | Street Address, City, State 501 Walnut Way, Palmetto, 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 GA00234285 was initiated at Fairburn Palmetto Dialysis on May 17, 2023 and concluded on May 17, 2023. The allegation was substantiated and the following standard level deficiency was cited: |