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General NPI Number Information
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NPI Number | 1932823853
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Entity Type | Organization
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Legal Business Name | DOWNTOWN WARNER ROBINS DIALYSIS, LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1205 WATSON BLVD STE A
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3423
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Country | US
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Telephone | 478-719-6971
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 WATSON BLVD STE A
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3423
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Country | US
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Telephone | 478-758-4526
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Fax | 478-745-8161
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS MARTINEZ
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Credential | MD
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Telephone | 478-758-4526
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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 |
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License Number State |
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Taxonomy #2
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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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