Healthcare Provider Details

I. General information

NPI: 1932823853
Provider Name (Legal Business Name): DOWNTOWN WARNER ROBINS DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 WATSON BLVD STE A
WARNER ROBINS GA
31093-3423
US

IV. Provider business mailing address

1205 WATSON BLVD STE A
WARNER ROBINS GA
31093-3423
US

V. Phone/Fax

Practice location:
  • Phone: 478-719-6971
  • Fax:
Mailing address:
  • Phone: 478-758-4526
  • Fax: 478-745-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS MARTINEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 478-758-4526