Provider Demographics
NPI:1457682379
Name:RAI CARE CENTERS OF GEORGIA I LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF GEORGIA I LLC
Other - Org Name:RAI-HARRIS ST.-SANDERSVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:614 S HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-2821
Mailing Address - Country:US
Mailing Address - Phone:478-552-6818
Mailing Address - Fax:478-552-0858
Practice Address - Street 1:614 S HARRIS ST
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-2821
Practice Address - Country:US
Practice Address - Phone:229-552-6818
Practice Address - Fax:229-552-0858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-15
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112534Medicare Oscar/Certification