Healthcare Provider Details

I. General information

NPI: 1720295561
Provider Name (Legal Business Name): NEPHROLOGY & HYPERTENSION SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 BROADRICK DR
DALTON GA
30720-3011
US

IV. Provider business mailing address

1506 BROADRICK DR
DALTON GA
30720-3011
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-3430
  • Fax: 706-279-1327
Mailing address:
  • Phone: 706-278-3430
  • Fax: 706-279-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID NEWBY
Title or Position: PRESIDENT
Credential: M.D
Phone: 706-278-3430