Provider Demographics
NPI:1386025906
Name:PHYSICIANS CHOICE DIALYSIS HOME, LLC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE DIALYSIS HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARACHELVI
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANDAYUTHAPANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-495-8900
Mailing Address - Street 1:711 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8908
Mailing Address - Country:US
Mailing Address - Phone:610-495-8900
Mailing Address - Fax:
Practice Address - Street 1:211 COMMERCE CT
Practice Address - Street 2:SUITE 104
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3483
Practice Address - Country:US
Practice Address - Phone:610-495-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment