Provider Demographics
NPI:1235114844
Name:DIALYSIS FACILITY OF ALMA, INC
Entity Type:Organization
Organization Name:DIALYSIS FACILITY OF ALMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PADMANABH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARAMREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-632-8010
Mailing Address - Street 1:415 S DIXON ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-3146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 UVALDA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4569
Practice Address - Country:US
Practice Address - Phone:912-285-2053
Practice Address - Fax:912-287-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD001239261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112744Medicare ID - Type UnspecifiedPROVIDER #
GAE01006Medicare UPIN