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NPI Code Detail

MEDICARE: DIALYSIS CENTER OF MACON LLC

MEDICARE: DIALYSIS CENTER OF MACON LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215327267
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALYSIS CENTER OF MACON LLC
Provider Business Mailing Address
First Line : 890 2ND ST
Second Line : 1ST FLOOR
City : MACON
State : GA
Zip : 31201-6863
Country : US
Telephone Number : 478-743-0584
Fax Number : 478-743-0585
Provider Business Practice Location Address
First Line : 890 2ND ST
Second Line : 1ST FLOOR
City : MACON
State : GA
Zip : 31201-6863
Country : US
Telephone Number : 478-743-0584
Fax Number : 478-743-0585
Authorized Official
Title or Position : CHIEF NURSING OFFICER
Name : SARA ANNE BRADY
Credential :
Telephone Number : 208-371-7878
Provider Enumeration Date : 01/29/2015
Last Update Date : 05/19/2026

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Directions to “DIALYSIS CENTER OF MACON LLC ” Practice Location

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