Organization
DIALYSIS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONOVAN SCHULTZ (PRESIDENT)
(615) 327-3061
Entity
Organization
Contact information
Practice address
201 THOMAS RD, FORT OGLETHORPE, GA 30742-3659
(706) 861-6668
(706) 861-6088
Mailing address
201 THOMAS RD, FORT OGLETHORPE, GA 30742-3659
(706) 861-6668
(706) 861-6088
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000452537E
—
GA
05
—
00452537E
—
TN
Enumeration date
07/08/2006
Last updated
10/04/2023
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