Healthcare Provider Details

I. General information

NPI: 1013941707
Provider Name (Legal Business Name): PHYSICIANS CHOICE DIALYSIS OF WEST GEORGIA II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 REDDING DR
BREMEN GA
30110-2283
US

IV. Provider business mailing address

211 COMMERCE CT SUITE 104
POTTSTOWN PA
19464-3483
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-0222
  • Fax: 770-537-1011
Mailing address:
  • Phone: 610-495-8900
  • Fax: 610-495-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberESRD001246
License Number StateGA

VIII. Authorized Official

Name: RHONDA B PALUMBO
Title or Position: DIRECTOR OF CONTRACTS/HR
Credential:
Phone: 610-495-8900