Provider Demographics
NPI:1780851139
Name:NEPHROLOGY CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:NEPHROLOGY CENTERS OF AMERICA LLC
Other - Org Name:WAYNESBORO DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3080
Mailing Address - Street 1:163 S LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-4580
Mailing Address - Country:US
Mailing Address - Phone:706-554-4668
Mailing Address - Fax:706-554-5175
Practice Address - Street 1:163 S LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-4580
Practice Address - Country:US
Practice Address - Phone:706-554-4668
Practice Address - Fax:706-554-5175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment