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General NPI Number Information
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NPI Number | 1649382466
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Entity Type | Organization
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Legal Business Name | DOUGLAS COUNTY DIALYSIS, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 4645 TIMBER RIDGE DR BLDG 200 STE 140
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7541
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Country | US
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Telephone | 678-838-3233
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Fax | 678-838-3236
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Provider Business Mailing Address
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Address Line | 4645 TIMBER RIDGE DR., BLDG 200 STE 140
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7541
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Country | US
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Telephone | 678-838-3233
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Fax | 678-838-3236
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BARRY L. BLANTON
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Credential |
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Telephone | 781-699-9000
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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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