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General NPI Number Information
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NPI Number | 1861667891
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE NEPHROLOGY CENTER PC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 415 BARTOW ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-6076
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Country | US
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Telephone | 229-226-6116
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Fax | 229-226-6128
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Provider Business Mailing Address
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Address Line | 415 BARTOW ST P.O. BOX 3027
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City | THOMASVILLE
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State | GA
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Zip | 31792-6076
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Country | US
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Telephone | 229-226-6116
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Fax | 229-226-6128
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Authorized Official
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Title or Position | OWNER
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Name | DR. DWIGHT A MCLEISH
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Credential | M.D.
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Telephone | 229-226-6116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 047235
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License Number State | GA
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