Organization
DIALYSIS ACCESS GROUP OF WAKE FOREST UNIVERSITY, LLC
Active
Other names
Dialysis Access Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY AGEE-CLARK JOHNSON MBA (CREDENTIALING COORD.)
(229) 387-3528
Entity
Organization
Contact information
Practice address
120 MILLER STREET, WINSTON SALEM, NC 27103-2500
(336) 723-1080
(336) 722-3040
Mailing address
PO BOX 7350, TIFTON, GA 31793-7350
(229) 387-3528
(229) 386-2149
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144279001
—
VA
05
—
5905783
—
NC
05
—
5916155
—
NC
Enumeration date
05/09/2006
Last updated
02/09/2026
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