Provider Demographics
NPI:1396733465
Name:GREENSBORO NEPHROLOGY
Entity type:Organization
Organization Name:GREENSBORO NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-433-0683
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-0390
Mailing Address - Country:US
Mailing Address - Phone:706-433-0683
Mailing Address - Fax:706-369-1478
Practice Address - Street 1:1220 SILOAM RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-2810
Practice Address - Country:US
Practice Address - Phone:706-433-0683
Practice Address - Fax:706-369-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3094Medicare ID - Type Unspecified
GA39BDBXSMedicare PIN