Organization
PEDERNALES DIALYSIS LLC
Active
Other names
Miller Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
213 DELORES ST, COLQUITT, GA 39837-3528
(229) 758-1985
(229) 758-2555
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003158694A
—
GA
Enumeration date
10/03/2014
Last updated
04/25/2019
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