Basic Information
| Provider Information | |||||||||
| NPI: | 1740706951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA LLC | ||||||||
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| OtherOrganizationName: | GEORGIA KIDNEY & HYPERTENSION CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 E RAY RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852258720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553970197 | ||||||||
| FaxNumber: | 8002726512 | ||||||||
| Practice Location | |||||||||
| Address1: | 334 SMITH AVE | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317925533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292271595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2017 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZUIKER | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR PRACTICE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2292271595 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.