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General NPI Number Information
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NPI Number | 1548905482
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Entity Type | Organization
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Legal Business Name | AVI GEORGIA ALBANY DIALYSIS LLC
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 507 W 3RD AVE STE 6B
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City | ALBANY
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State | GA
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Zip | 31701-1946
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Country | US
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Telephone | 413-800-9383
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Fax |
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Provider Business Mailing Address
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Address Line | 507 W 3RD AVE STE 6B
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City | ALBANY
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State | GA
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Zip | 31701-1946
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AMAN KHANUJA
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Credential |
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Telephone | 413-800-9383
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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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