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General NPI Number Information
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NPI Number | 1154806594
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Entity Type | Organization
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Legal Business Name | RENAL ASSOCIATES OF LAGRANGE AT EMORY LLC
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 1300 LAFAYETTE PKWY STE D
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City | LAGRANGE
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State | GA
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Zip | 30241-2610
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Country | US
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Telephone | 706-882-2800
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Fax | 706-324-3419
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Provider Business Mailing Address
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Address Line | 6228 BRADLEY PARK DR STE A
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City | COLUMBUS
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State | GA
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Zip | 31904-3605
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Country | US
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Telephone | 706-322-1486
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Fax | 706-324-3419
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BEVERLY REYNOLDS
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Credential |
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Telephone | 706-322-1486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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