Provider Demographics
NPI:1326207002
Name:GEORGIA RENAL SPECIALISTS
Entity Type:Organization
Organization Name:GEORGIA RENAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERIC
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:404-352-8500
Mailing Address - Street 1:105 COLLIER RD NW STE 1040
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1730
Mailing Address - Country:US
Mailing Address - Phone:404-352-8522
Mailing Address - Fax:404-352-8300
Practice Address - Street 1:105 COLLIER RD NW STE 1040
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1730
Practice Address - Country:US
Practice Address - Phone:404-352-8522
Practice Address - Fax:404-352-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060340207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty