Provider Demographics
NPI:1114344926
Name:NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC
Entity Type:Organization
Organization Name:NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC
Other - Org Name:DAVITA KIDNEY SPECIALISTS OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. RCM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-935-3971
Mailing Address - Street 1:10333 SOUTHPOINT LANDING BLVD STE 161
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8042
Mailing Address - Country:US
Mailing Address - Phone:540-899-3107
Mailing Address - Fax:540-899-3183
Practice Address - Street 1:10333 SOUTHPOINT LANDING BLVD STE 161
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8042
Practice Address - Country:US
Practice Address - Phone:540-899-3107
Practice Address - Fax:540-899-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD719Medicare PIN