Provider Demographics
| NPI: | 1356879902 |
|---|---|
| Name: | NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC |
| Entity type: | Organization |
| Organization Name: | NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OPERATIONS MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TRISH |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ROTUREAU |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 912-354-4813 |
| Mailing Address - Street 1: | PO BOX 15238 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAVANNAH |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 31416-1938 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 912-354-4813 |
| Mailing Address - Fax: | 912-354-7569 |
| Practice Address - Street 1: | 3025 SHRINE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | BRUNSWICK |
| Practice Address - State: | GA |
| Practice Address - Zip Code: | 31520-4784 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 912-354-4813 |
| Practice Address - Fax: | 912-354-7569 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2017-05-26 |
| Last Update Date: | 2017-05-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |