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NPI Code Detail

MEDICARE: DIALYSIS CLINIC INC.

MEDICARE: DIALYSIS CLINIC INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/CenterESRD001096GA

Other Identifiers

General Provider Information

NPI Number : 1023041506
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALYSIS CLINIC INC.
Provider Business Mailing Address
First Line : 2424 WARM SPRINGS RD
Second Line : SUITE B
City : COLUMBUS
State : GA
Zip : 31904-6862
Country : US
Telephone Number : 706-322-1959
Fax Number : 706-322-9393
Provider Business Practice Location Address
First Line : 2821 WARM SPRINGS RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-6842
Country : US
Telephone Number : 706-323-2415
Fax Number : 706-323-2564
Authorized Official
Title or Position : PRESIDENT
Name : MR. DONOVAN SCHULTZ
Credential :
Telephone Number : 615-327-3061
Provider Enumeration Date : 07/08/2006
Last Update Date : 10/04/2023

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