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General NPI Number Information
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NPI Number | 1619473352
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Entity Type | Organization
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Legal Business Name | DUBLIN KIDNEY INSTITUTE
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 207 INDUSTRIAL BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-2903
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Country | US
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Telephone | 478-353-3575
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6799
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City | MACON
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State | GA
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Zip | 31208-6799
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Country | US
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Telephone | 478-353-3575
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | REUBEN K. ELLIS
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Credential | MD
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Telephone | 478-353-3575
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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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