Organization Name: | HEPHZIBAH DIALYSIS CLINIC LLC |
NPI Number: | 1477994184 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN J. MCDONOUGH (COO) |
Mailing Address: | 2516 Tobacco Rd Hephzibah |
State: | GA US |
Postal Code: | 308157099 |
Phone Number: | 7067909314 |
Fax Number: | 7067909315 |
NPI Enumeration Date: | 07/10/2013 |
NPI Last Update Date: | 04/17/2015 |
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: |