Healthcare Provider Details

I. General information

NPI: 1689643306
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS MID ATLANTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 EAST BURKHALTER AVE SUITE A
BUENA VISTA GA
31803-1701
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 229-649-5017
  • Fax: 229-649-6410
Mailing address:
  • Phone: 615-320-4286
  • Fax: 866-594-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberESRD001122
License Number StateGA

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4500