Provider Demographics
NPI:1104015569
Name:SOUTHWEST GA. NEPHROLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:SOUTHWEST GA. NEPHROLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-888-3970
Mailing Address - Street 1:1200 N JEFFERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2057
Mailing Address - Country:US
Mailing Address - Phone:229-888-3970
Mailing Address - Fax:229-889-9386
Practice Address - Street 1:1200 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2057
Practice Address - Country:US
Practice Address - Phone:229-888-3970
Practice Address - Fax:229-889-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAH708815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP900Medicare PIN