Provider Demographics
NPI:1508025735
Name:GEORGIA DIALYSIS ACCESS CENTER PC
Entity Type:Organization
Organization Name:GEORGIA DIALYSIS ACCESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LUDWIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALIERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-745-5486
Mailing Address - Street 1:889 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6862
Mailing Address - Country:US
Mailing Address - Phone:847-388-2065
Mailing Address - Fax:866-720-9740
Practice Address - Street 1:889 2ND ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6862
Practice Address - Country:US
Practice Address - Phone:847-388-2065
Practice Address - Fax:866-720-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty