Organization
NRA MACON GEORGIA LLC
Active
Parent organization
RAI II, LLC
Other names
Eisenhower Parkway Dialysis Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
RAI II, LLC
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
2525 2ND ST, MACON, GA 31206-2223
(478) 738-0420
(478) 745-0460
Mailing address
1550 W. MCEWEN DRIVE, SUITE 500, FRANKLIN, TN 37067-1731
(615) 661-1100
(615) 507-3300
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001230
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1049748
CLIA CERTIFICATE OF WAIVE
GA
05
—
813786518A
—
GA
Enumeration date
05/26/2006
Last updated
07/22/2015
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