Healthcare Provider Details

I. General information

NPI: 1356879902
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SHRINE RD
BRUNSWICK GA
31520-4784
US

IV. Provider business mailing address

PO BOX 15238
SAVANNAH GA
31416-1938
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-4813
  • Fax: 912-354-7569
Mailing address:
  • Phone: 912-354-4813
  • Fax: 912-354-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRISH ROTUREAU
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 912-354-4813