Healthcare Provider Details

I. General information

NPI: 1407588205
Provider Name (Legal Business Name): NEPHROLOGY GROUP CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 01/30/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 OCILLA RD
DOUGLAS GA
31533-2230
US

IV. Provider business mailing address

1001 WARD ST W
DOUGLAS GA
31533-2263
US

V. Phone/Fax

Practice location:
  • Phone: 912-384-7210
  • Fax: 912-384-5130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: THET N ZAW
Title or Position: CEO
Credential: MD
Phone: 912-209-4600