Healthcare Provider Details

I. General information

NPI: 1356753586
Provider Name (Legal Business Name): DIALYSIS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W LAKE PROFESSIONAL PARK SUITE 7
GENEVA AL
36340-1203
US

IV. Provider business mailing address

1630 COLUMBIA HWY
DOTHAN AL
36303-5434
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-0175
  • Fax: 334-684-0368
Mailing address:
  • Phone: 334-793-3519
  • Fax: 334-699-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONOVAN SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 615-327-3061