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General NPI Number Information
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NPI Number | 1962708891
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Entity Type | Organization
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Legal Business Name | KIDNEY CENTER OF CENTRAL GEORGIA, LLC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 657 HEMLOCK ST STE 200
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City | MACON
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State | GA
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Zip | 31201-8324
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Country | US
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Telephone | 478-254-7353
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Fax | 478-254-7350
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Provider Business Mailing Address
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Address Line | 657 HEMLOCK ST STE 200
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City | MACON
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State | GA
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Zip | 31201-8324
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Country | US
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Telephone | 478-461-3291
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Fax | 478-254-7353
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | RACHAEL DENISE TISDALE
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Credential |
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Telephone | 478-254-7353
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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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