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NPI Code Detail

MEDICARE: RENAL ASSOCIATES, LLC

MEDICARE: RENAL ASSOCIATES, LLC
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
1207RN0300XNephrology Physician038662,049226,053587GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CI3630OTHERGARAILROAD MEDICARE GROUP #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205944311
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAL ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 6228 BRADLEY PARK DR
Second Line : SUITE A
City : COLUMBUS
State : GA
Zip : 31904-3603
Country : US
Telephone Number : 706-322-1486
Fax Number : 706-324-3419
Provider Business Practice Location Address
First Line : 6228 BRADLEY PARK DR
Second Line : SUITE A
City : COLUMBUS
State : GA
Zip : 31904-3603
Country : US
Telephone Number : 706-322-1486
Fax Number : 706-324-3419
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. BEVERLY REYNOLDS
Credential :
Telephone Number : 706-322-1486
Provider Enumeration Date : 08/28/2006
Last Update Date : 12/16/2022

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Directions to “RENAL ASSOCIATES, LLC ” Practice Location

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