Organization
MACON SOUTHSIDE DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
2117 EISENHOWER PKWY, MACON, GA 31206-3185
(478) 744-9551
(478) 744-9553
Mailing address
2117 EISENHOWER PKWY, MACON, GA 31206-3185
(478) 744-9551
(478) 744-9553
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003159743A
—
GA
Enumeration date
12/01/2014
Last updated
01/10/2023
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