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General NPI Number Information
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NPI Number | 1740241728
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Entity Type | Organization
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Legal Business Name | ACUTE DIALYSIS
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 729 S PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31601-6069
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Country | US
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Telephone | 229-242-9610
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Fax | 229-242-9054
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Provider Business Mailing Address
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Address Line | 729 S PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31601-6069
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Country | US
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Telephone | 229-242-9610
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Fax | 229-242-9054
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Authorized Official
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Title or Position | ADMINISTRATOR/ PARTNER
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Name | MRS. GENEVA M. RAY
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Credential | REGISTERED NURSE
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Telephone | 229-242-9610
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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 | ESRD001234
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License Number State | GA
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