Organization
DEMOREST DIALYSIS FACILITY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTY W DUNCAN (BILLING SPECIALIST)
(706) 433-0683
Entity
Organization
Contact information
Practice address
1507 CENTRAL AVE, DEMOREST, GA 30535-4555
(706) 433-0683
(706) 369-1478
Mailing address
PO BOX 6385, ATHENS, GA 30604-6385
(706) 546-0083
(706) 613-9205
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001213
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
885141164A
—
GA
Enumeration date
10/12/2005
Last updated
03/15/2011
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