Healthcare Provider Details

I. General information

NPI: 1831272186
Provider Name (Legal Business Name): NRA-GRAY, GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 BOULDER DR.
GRAY GA
31032
US

IV. Provider business mailing address

1550 W. MCEWEN DRIVE SUITE 500
FRANKLIN TN
37067-1731
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-4400
  • Fax: 615-771-4401
Mailing address:
  • Phone: 615-661-1100
  • Fax: 615-507-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JON M. SUNDOCK
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-507-3307