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General NPI Number Information
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NPI Number | 1265491492
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Entity Type | Organization
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Legal Business Name | RENAL TREATMENT CENTERS MID ATLANTIC INC
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 11685 ALPHARETTA HWY # 100
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City | ROSWELL
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State | GA
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Zip | 30076-4913
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Country | US
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Telephone | 678-393-8144
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Fax | 678-393-8787
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY SUITE 400 L&C
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone | 615-324-1638
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Fax | 303-209-7942
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Authorized Official
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Title or Position | GROUP VICE PRESIDENT
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Name | THOMAS O USILTON JR.
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Credential |
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Telephone | 770-541-7922
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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 | ESRD001056
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License Number State | GA
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