Provider Demographics
NPI:1952819419
Name:PUTNAM DIALYSIS LLC
Entity Type:Organization
Organization Name:PUTNAM DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUFID
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-254-7353
Mailing Address - Street 1:301 SOUTH JEFFERSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024
Mailing Address - Country:US
Mailing Address - Phone:706-485-1724
Mailing Address - Fax:706-485-7043
Practice Address - Street 1:301 SOUTH JEFFERSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024
Practice Address - Country:US
Practice Address - Phone:706-485-1724
Practice Address - Fax:706-485-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment