Provider Demographics
NPI:1861667891
Name:COMPREHENSIVE NEPHROLOGY CENTER PC
Entity Type:Organization
Organization Name:COMPREHENSIVE NEPHROLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCLEISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-226-6116
Mailing Address - Street 1:415 BARTOW ST
Mailing Address - Street 2:P.O. BOX 3027
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6076
Mailing Address - Country:US
Mailing Address - Phone:229-226-6116
Mailing Address - Fax:229-226-6128
Practice Address - Street 1:415 BARTOW ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6076
Practice Address - Country:US
Practice Address - Phone:229-226-6116
Practice Address - Fax:229-226-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047235261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty