Provider Demographics
NPI:1790706455
Name:RENAL HYPERTENSION CLINIC PC
Entity Type:Organization
Organization Name:RENAL HYPERTENSION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKKARAJU
Authorized Official - Middle Name:VS
Authorized Official - Last Name:SARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:912-384-7210
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2650
Mailing Address - Country:US
Mailing Address - Phone:912-384-7210
Mailing Address - Fax:912-384-5130
Practice Address - Street 1:190 WESTSIDE DR
Practice Address - Street 2:B
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3533
Practice Address - Country:US
Practice Address - Phone:912-384-7210
Practice Address - Fax:912-384-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00257463EMedicaid
GA00257463AMedicaid
GA00257463EMedicaid