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General NPI Number Information
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NPI Number | 1295882454
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Entity Type | Organization
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Legal Business Name | MEDICAL KIDNEY SERVICES OF CENTRAL GEORGIA, LTD.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 521 W MONTGOMERY ST #14A
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-3293
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Country | US
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Telephone | 478-453-2031
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Fax | 478-452-5225
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Provider Business Mailing Address
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Address Line | PO BOX 4207
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City | MACON
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State | GA
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Zip | 31208-4207
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Country | US
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Telephone | 478-453-2031
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHIRLEY C ROWLAND
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Credential |
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Telephone | 478-453-2031
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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 | GA
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