Organization
RENAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY REYNOLDS (OFFICE MANAGER)
(706) 322-1486
Entity
Organization
Contact information
Practice address
6228 BRADLEY PARK DR, SUITE A, COLUMBUS, GA 31904-3603
(706) 322-1486
(706) 324-3419
Mailing address
6228 BRADLEY PARK DR, SUITE A, COLUMBUS, GA 31904-3603
(706) 322-1486
(706) 324-3419
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
038662,049226,053587
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55003365A
—
GA
01
—
CI3630
RAILROAD MEDICARE GROUP #
GA
Enumeration date
08/28/2006
Last updated
12/16/2022
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