Organization Name: | DCA OF HAWKINSVILLE LLC |
NPI Number: | 1124081559 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS L WEINBERG (VICE PRESIDENT & SECRETARY) |
Mailing Address: | 292 Industrial Blvd Ste 100 Hawkinsville |
State: | GA US |
Postal Code: | 310368002 |
Phone Number: | 4788928008 |
Fax Number: | 4788928040 |
NPI Enumeration Date: | 04/07/2006 |
NPI Last Update Date: | 10/13/2014 |
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: |