| Organization Name: | WAYCROSS DIALYSIS FACILITY, INC |
| NPI Number: | 1083601678 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PADMANABH MARAMREDDY (MEDICAL DIRECTOR) |
| Mailing Address: | 220 Uvalda St Waycross |
| State: | GA US |
| Postal Code: | 315014569 |
| Phone Number: | 9122852487 |
| Fax Number: | 9122871731 |
| NPI Enumeration Date: | 09/29/2005 |
| NPI Last Update Date: | 10/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |