Organization Name: | DVA HEALTHCARE RENAL CARE INC |
NPI Number: | 1366411381 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
Mailing Address: | 1747 Langford Dr Bldg 500 Bogart |
State: | GA US |
Postal Code: | 306222670 |
Phone Number: | 7065831785 |
Fax Number: | 7065831943 |
NPI Enumeration Date: | 03/14/2006 |
NPI Last Update Date: | 11/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | ESRD001066 |
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: |