Provider Demographics
NPI:1164850533
Name:NEPHROLOGY MEDICAL ASSOCIATES OF GA, LLC
Entity Type:Organization
Organization Name:NEPHROLOGY MEDICAL ASSOCIATES OF GA, LLC
Other - Org Name:MUSKINGUM MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-536-2402
Mailing Address - Street 1:2000 16TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5158
Mailing Address - Country:US
Mailing Address - Phone:303-876-7243
Mailing Address - Fax:866-917-5396
Practice Address - Street 1:3777 JAMES CT
Practice Address - Street 2:SUITE 1
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8127
Practice Address - Country:US
Practice Address - Phone:740-453-5003
Practice Address - Fax:740-452-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty