Organization
LOUISVILLE DIALYSIS CLINIC-PEACHTREE LLC
Active
Organization
LOUISVILLE DIALYSIS CLINIC-PEACHTREE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN WILCOX (CFO)
(978) 922-3080
Entity
Organization
Contact information
Practice address
1069 PEACHTREE ST, LOUISVILLE, GA 30434-1558
(478) 625-9566
(478) 625-9567
Mailing address
1069 PEACHTREE ST, LOUISVILLE, GA 30434-1558
(478) 625-9566
(478) 625-9567
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
—
000814184A
—
GA
Enumeration date
12/09/2014
Last updated
03/16/2017
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