Healthcare Provider Details

I. General information

NPI: 1205944311
Provider Name (Legal Business Name): RENAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 BRADLEY PARK DR SUITE A
COLUMBUS GA
31904-3603
US

IV. Provider business mailing address

6228 BRADLEY PARK DR SUITE A
COLUMBUS GA
31904-3603
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-1486
  • Fax: 706-324-3419
Mailing address:
  • Phone: 706-322-1486
  • Fax: 706-324-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number038662,049226,053587
License Number StateGA

VIII. Authorized Official

Name: MRS. BEVERLY REYNOLDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-322-1486