Provider Demographics
NPI:1851392476
Name:RENAL PHYSICIANS OF GEORGIA PC
Entity Type:Organization
Organization Name:RENAL PHYSICIANS OF GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:O
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-741-2150
Mailing Address - Street 1:165 EMERY HWY
Mailing Address - Street 2:100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3666
Mailing Address - Country:US
Mailing Address - Phone:478-741-2150
Mailing Address - Fax:478-741-2208
Practice Address - Street 1:165 EMERY HWY
Practice Address - Street 2:100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3666
Practice Address - Country:US
Practice Address - Phone:478-741-2150
Practice Address - Fax:478-741-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACJ4042OtherRAILROAD MEDICARE GROUP
GAGRP3686Medicare PIN
GAH13375Medicare UPIN
GACJ4042OtherRAILROAD MEDICARE GROUP