| Organization Name: | DEMOREST DIALYSIS FACILITY, L.L.C. |
| NPI Number: | 1215925375 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTY W DUNCAN (BILLING SPECIALIST) |
| Mailing Address: | 1507 Central Ave Demorest |
| State: | GA US |
| Postal Code: | 305354555 |
| Phone Number: | 7064330683 |
| Fax Number: | 7063691478 |
| NPI Enumeration Date: | 10/12/2005 |
| NPI Last Update Date: | 03/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | ESRD001213 |
| 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: | |