Healthcare Provider Details

I. General information

NPI: 1033560222
Provider Name (Legal Business Name): FORTWORTH RENAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 WINDSOR PL STE 102
FORT WORTH TX
76110-1866
US

IV. Provider business mailing address

1902 WINDSOR PL STE 102
FORT WORTH TX
76110-1866
US

V. Phone/Fax

Practice location:
  • Phone: 682-207-1700
  • Fax: 682-250-5246
Mailing address:
  • Phone: 682-207-1700
  • Fax: 682-250-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLADAPO AFOLABI
Title or Position: CEO
Credential: MD
Phone: 817-360-6081