Provider Demographics
NPI:1013941707
Name:PHYSICIANS CHOICE DIALYSIS OF WEST GEORGIA II, LLC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE DIALYSIS OF WEST GEORGIA II, LLC
Other - Org Name:PCD BREMEN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CONTRACTS/HR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-495-8900
Mailing Address - Street 1:211 COMMERCE CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3483
Mailing Address - Country:US
Mailing Address - Phone:610-495-8900
Mailing Address - Fax:610-495-8560
Practice Address - Street 1:108 REDDING DR
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2283
Practice Address - Country:US
Practice Address - Phone:770-537-0222
Practice Address - Fax:770-537-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD001246261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112751Medicare ID - Type UnspecifiedMEDICARE PROVIDER #