Organization Name: | BARNESVILLE DIALYSIS, LLC |
NPI Number: | 1003856840 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MOHAMAD MOUSSA KASSEM (PRESIDENT) |
Mailing Address: | 783 Highway 341 S Barnesville |
State: | GA US |
Postal Code: | 302043793 |
Phone Number: | 7703581142 |
Fax Number: | 7703581503 |
NPI Enumeration Date: | 06/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | ESRD001248 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |