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Organization
DIALYSIS ACCESS GROUP OF WAKE FOREST UNIVERSITY, LLC
Active
Organization
DIALYSIS ACCESS GROUP OF WAKE FOREST UNIVERSITY, LLC
Active
Other names
Dialysis Access Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY AGEE-CLARK JOHNSON MBA (CREDENTIALING COORD.)
(229) 387-3528
Entity
Organization
Contact information
Practice address
120 MILLER STREET, WINSTON SALEM, NC 27103-2500
(336) 723-1080
(336) 722-3040
Mailing address
PO BOX 7350, TIFTON, GA 31793-7350
(229) 387-3528
(229) 386-2149
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144279001
—
VA
05
—
5905783
—
NC
05
—
5916155
—
NC
Enumeration date
05/09/2006
Last updated
02/09/2026
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