Organization
VALDOSTA KIDNEY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA ESTER CHIANG (MANAGER)
(229) 244-6544
Entity
Organization
Contact information
Practice address
410 COWART AVE, VALDOSTA, GA 31602-2622
(229) 244-6544
(229) 241-9744
Mailing address
PO BOX 2267, VALDOSTA, GA 31604-2267
(229) 244-6544
(229) 241-9744
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
054594
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC4801
RAILROAD MEDICARE GROUP
GA
01
—
GRP6735
MEDICARE ID
—
Enumeration date
04/01/2008
Last updated
04/05/2012
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