Provider Demographics
NPI:1295219103
Name:RENAL ASSOCIATES OF LAGRANGE LLC
Entity Type:Organization
Organization Name:RENAL ASSOCIATES OF LAGRANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-322-1486
Mailing Address - Street 1:6228 BRADLEY PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3605
Mailing Address - Country:US
Mailing Address - Phone:706-322-1486
Mailing Address - Fax:706-324-3419
Practice Address - Street 1:1300 LAFAYETTE PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2610
Practice Address - Country:US
Practice Address - Phone:706-322-1486
Practice Address - Fax:706-324-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty