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General NPI Number Information
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NPI Number | 1225085004
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Entity Type | Organization
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Legal Business Name | NRA-EATONTON, GEORGIA, LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 130 HOSPITAL PERIMETER RD
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City | EATONTON
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State | GA
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Zip | 31024-8502
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Country | US
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Telephone | 706-484-0123
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Fax | 706-484-0959
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Provider Business Mailing Address
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Address Line | 1550 W. MCEWEN DRIVE SUITE 500
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City | FRANKLIN
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State | TN
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Zip | 37067-1731
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Country | US
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Telephone | 615-661-1100
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Fax | 615-507-3300
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JON M. SUNDOCK
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Credential |
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Telephone | 615-507-3307
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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 | ESRD001102
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License Number State | GA
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