| Organization Name: | NRA-EATONTON, GEORGIA, LLC |
| NPI Number: | 1225085004 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JON M. SUNDOCK (VICE PRESIDENT) |
| Mailing Address: | 130 Hospital Perimeter Rd Eatonton |
| State: | GA US |
| Postal Code: | 310248502 |
| Phone Number: | 7064840123 |
| Fax Number: | 7064840959 |
| NPI Enumeration Date: | 05/27/2006 |
| NPI Last Update Date: | 02/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | ESRD001102 |
| 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: | |