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General NPI Number Information
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NPI Number | 1841691250
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY MEDICAL ASSOCIATES OF GA, LLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 315 SE STONEMILL DR SUITE 220
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City | VANCOUVER
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State | WA
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Zip | 98684-6998
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Country | US
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Telephone | 503-284-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 16TH ST
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City | DENVER
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State | CO
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Zip | 80202-5158
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Country | US
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Telephone | 303-876-7243
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Fax | 866-917-5396
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Authorized Official
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Title or Position | GENERAL MANAGER/VICE PRESIDENT
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Name | DERON FRANK
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Credential |
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Telephone | 310-536-2402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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