Provider Demographics
NPI:1952726945
Name:RENALSOUTH OF ROME LLC
Entity Type:Organization
Organization Name:RENALSOUTH OF ROME LLC
Other - Org Name:RENALSOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-815-6541
Mailing Address - Street 1:117 GEMINI CIR
Mailing Address - Street 2:SUITE 418
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5874
Mailing Address - Country:US
Mailing Address - Phone:205-815-6541
Mailing Address - Fax:855-291-1660
Practice Address - Street 1:315 W 10TH ST NE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2676
Practice Address - Country:US
Practice Address - Phone:706-314-9170
Practice Address - Fax:855-687-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD000684261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112888Medicare Oscar/Certification