Provider Demographics
NPI:1831469485
Name:RELIANT RENAL CARE - GEORGIA, LLC
Entity Type:Organization
Organization Name:RELIANT RENAL CARE - GEORGIA, LLC
Other - Org Name:PIEDMONT DIALYSIS NORTH
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 1:1720 POWDER SPRINGS RD SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4899
Mailing Address - Country:US
Mailing Address - Phone:678-402-6048
Mailing Address - Fax:770-693-8873
Practice Address - Street 1:1720 POWDER SPRINGS RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4899
Practice Address - Country:US
Practice Address - Phone:678-402-6048
Practice Address - Fax:770-693-8873
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2023-10-20
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
GA003126618AMedicaid
112850Medicare Oscar/Certification