| Organization Name: | SPALDING COUNTY DIALYSIS, LLC |
| NPI Number: | 1023058898 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOHAMAD MOUSSA KASSEM (PRESIDENT) |
| Mailing Address: | 1570 Williamson Rd Griffin |
| State: | GA US |
| Postal Code: | 302243931 |
| Phone Number: | 7704678116 |
| Fax Number: | 7704678116 |
| 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: | ESRD001194 |
| 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: | |