Organization
NRA MONTICELLO GEORGIA LLC
Active
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
Update your record
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