Organization Name: | NRA MACON GEORGIA LLC |
NPI Number: | 1033165154 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JON M. SUNDOCK (VICE PRESIDENT) |
Mailing Address: | 2525 2nd St Macon |
State: | GA US |
Postal Code: | 312062223 |
Phone Number: | 4787380420 |
Fax Number: | 4787450460 |
NPI Enumeration Date: | 05/26/2006 |
NPI Last Update Date: | 07/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | ESRD001230 |
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: |