Provider Demographics
NPI:1184650517
Name:NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC
Entity type:Organization
Organization Name:NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-382-1910
Mailing Address - Street 1:1832 CENTRE POINT CIR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1438
Mailing Address - Country:US
Mailing Address - Phone:630-836-8724
Mailing Address - Fax:866-594-9002
Practice Address - Street 1:1207 STATE ROUTE VV
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3823
Practice Address - Country:US
Practice Address - Phone:636-970-0249
Practice Address - Fax:636-970-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty