Provider Demographics
NPI:1922339845
Name:RAI CARE CENTERS OF GEORGIA I LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF GEORGIA I LLC
Other - Org Name:RAI-PEACH ORCHARD RD-AUGUSTA
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:3206 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3540
Mailing Address - Country:US
Mailing Address - Phone:706-798-5774
Mailing Address - Fax:706-796-3465
Practice Address - Street 1:3206 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3540
Practice Address - Country:US
Practice Address - Phone:706-798-5774
Practice Address - Fax:706-796-1236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-15
Last Update Date:2014-11-18
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
GA112669Medicare Oscar/Certification