Provider Demographics
NPI:1255506721
Name:SOUTHWEST GA NEPHROLOGY CLINIC PC
Entity Type:Organization
Organization Name:SOUTHWEST GA NEPHROLOGY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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 NORTH JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-2508
Mailing Address - Country:US
Mailing Address - Phone:229-888-3970
Mailing Address - Fax:229-888-7771
Practice Address - Street 1:1302 N 5TH STREET EXT
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3734
Practice Address - Country:US
Practice Address - Phone:229-888-3970
Practice Address - Fax:229-888-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAH708815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty