Organization
WAYCROSS DIALYSIS FACILITY, INC
Active
Organization
WAYCROSS DIALYSIS FACILITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PADMANABH MARAMREDDY M.D. (MEDICAL DIRECTOR)
(912) 285-2487
Entity
Organization
Contact information
Practice address
220 UVALDA ST, WAYCROSS, GA 31501-4569
(912) 285-2487
(912) 287-1731
Mailing address
220 UVALDA ST, WAYCROSS, GA 31501-4569
(912) 285-2487
(912) 287-1731
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
—
000183719D
—
GA
05
—
000192772A
—
GA
05
—
000408944A
—
GA
01
—
51000007
BCBS
GA
Enumeration date
09/29/2005
Last updated
10/07/2011
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