MEDLOCK BRIDGE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Jasper, GA. MEDLOCK BRIDGE DIALYSIS LLC NPI is 1245869619. The provider is registered as an organization entity type.
The provider Is Doing Business As Mountainside Dialysis.
The provider's business location address is:
700 N MAIN ST
JASPER, GA
ZIP 30143-404
Phone: (678) 387-1274
Fax: (678) 387-1292
The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.
The CLIA number assigned to this NPI record is 11D2188461 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 4/7/2020 and was last updated on 11/27/2023.