Provider Demographics
NPI:1740241728
Name:ACUTE DIALYSIS
Entity type:Organization
Organization Name:ACUTE DIALYSIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:229-242-9610
Mailing Address - Street 1:729 S PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-6069
Mailing Address - Country:US
Mailing Address - Phone:229-242-9610
Mailing Address - Fax:229-242-9054
Practice Address - Street 1:729 S PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-6069
Practice Address - Country:US
Practice Address - Phone:229-242-9610
Practice Address - Fax:229-242-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD001234261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment