Provider Demographics
NPI:1760681506
Name:NRA-PALMETTO, GEORGIA, LLC
Entity Type:Organization
Organization Name:NRA-PALMETTO, GEORGIA, LLC
Other - Org Name:PALMETTO DIALYSIS CLINIC
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 1:500 WALNUT WAY
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2092
Mailing Address - Country:US
Mailing Address - Phone:770-463-1442
Mailing Address - Fax:770-463-1337
Practice Address - Street 1:500 WALNUT WAY
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-2092
Practice Address - Country:US
Practice Address - Phone:770-463-1442
Practice Address - Fax:770-463-1337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-12
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD000788261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D1072364OtherCLIA
GA315856063AMedicaid
GA315856063AMedicaid