Provider Demographics
NPI:1982009676
Name:NCG HOME DIALYSIS OF BARROW COUNTY LLC
Entity Type:Organization
Organization Name:NCG HOME DIALYSIS OF BARROW COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-282-1100
Mailing Address - Street 1:655 EXCHANGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-1767
Mailing Address - Country:US
Mailing Address - Phone:770-282-1100
Mailing Address - Fax:
Practice Address - Street 1:655 EXCHANGE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-1767
Practice Address - Country:US
Practice Address - Phone:770-282-1100
Practice Address - Fax:770-282-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment