Organization
NRA MONTICELLO GEORGIA LLC
Active
Other names
Monticello Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
1393 FUNDERBURG DR, MONTICELLO, GA 31064-6818
(706) 468-1240
(706) 468-5300
Mailing address
1550 W. MCEWEN DRIVE, SUITE 500, FRANKLIN, TN 37067-1731
(615) 661-1100
(615) 507-3300
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001221
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1049750
CLIA CERTIFICATE OF WAIVE
GA
05
—
419934334A
—
GA
Enumeration date
05/27/2006
Last updated
07/22/2015
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