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General NPI Number Information
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NPI Number | 1972833267
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Entity Type | Organization
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Legal Business Name | ADDISON KIDNEY CONSULTING PLLC
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 331 LAIDLEY ST SUITE 307
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City | CHARLESTON
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State | WV
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Zip | 25301-1619
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Country | US
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Telephone | 304-208-1414
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Fax | 304-344-2108
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Provider Business Mailing Address
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Address Line | 331 LAIDLEY ST STE 204
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City | CHARLESTON
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State | WV
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Zip | 25301-1605
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Country | US
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Telephone | 304-205-7790
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Fax | 304-205-7792
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JEFFERY F. ADDISON
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Credential | M.D.
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Telephone | 304-205-7790
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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 | 15775
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License Number State | WV
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