Healthcare Provider Details

I. General information

NPI: 1508025735
Provider Name (Legal Business Name): GEORGIA DIALYSIS ACCESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 2ND ST
MACON GA
31201-6862
US

IV. Provider business mailing address

889 2ND ST
MACON GA
31201-6862
US

V. Phone/Fax

Practice location:
  • Phone: 847-388-2065
  • Fax: 866-720-9740
Mailing address:
  • Phone: 847-388-2065
  • Fax: 866-720-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LUDWIG CAVALIERE
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 478-745-5486