Provider Demographics
NPI:1689786493
Name:BIO-MEDICAL APPLICATIONS OF GEORGIA, INC.
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF GEORGIA, INC.
Other - Org Name:WEST CHATHAM DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:113 MINUS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-2119
Mailing Address - Country:US
Mailing Address - Phone:912-965-0305
Mailing Address - Fax:912-965-0501
Practice Address - Street 1:113 MINUS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2119
Practice Address - Country:US
Practice Address - Phone:912-965-0305
Practice Address - Fax:912-965-0501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-10-24
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
GA112716Medicare Oscar/Certification