DIALYSIS CENTER OF MILLEDGEVILLE LLC NPI 1881076545

NPI Information

NPI: 1881076545
Provider Name: DIALYSIS CENTER OF MILLEDGEVILLE LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 11D2101934

Address:
1520 N. COLUMBIA STREET
SUITE 100
MILLEDGEVILLE, GA
ZIP 31061
Phone: (478) 414-0123
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DIALYSIS CENTER OF MILLEDGEVILLE LLC is an end-stage renal disease (esrd) treatment clinic center in Milledgeville, GA. DIALYSIS CENTER OF MILLEDGEVILLE LLC NPI is 1881076545. The provider is registered as an organization entity type.

The provider's business location address is:

1520 N. COLUMBIA STREET
SUITE 100
MILLEDGEVILLE, GA
ZIP 31061-474
Phone: (478) 414-0123
Fax: (478) 414-0129

The provider's authorized official is Sara Anne Brady .
The authorized official title is Chief Nursing Officer and has the following contact phone number (208) 371-7878.

The CLIA number assigned to this NPI record is 11D2101934 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/18/2015 and was last updated on 1/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment		GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003174932A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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