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General NPI Number Information
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NPI Number | 1073057295
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Entity Type | Organization
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Legal Business Name | PURE LIFE RENAL OF PERIMETER, LLC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 6160 PEACHTREE DUNWOODY RD SUITE A-110
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City | ATLANTA
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State | GA
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Zip | 30328-4578
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Country | US
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Telephone | 954-962-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 HOLLYWOOD BLVD SUITE 300N
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6751
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Country | US
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Telephone | 954-962-5734
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. JEFF FERNANDEZ
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Credential |
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Telephone | 954-962-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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