Organization
DOUGLASVILLE DIALYSIS SPA DDS
Active
Other names
DDS
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENELL HARRIS (FACILITY ADMINISTRATOR)
(678) 903-4470
Entity
Organization
Contact information
Practice address
3138 GOLF RIDGE BLVD, DOUGLASVILE, GA 30135
(770) 485-1773
(770) 627-3202
Mailing address
1380 VETERAMS MEMORIAL HWY SW, MABLETON, GA 30126
(770) 485-1773
(770) 627-3202
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
GA
Other
Enumeration date
08/05/2013
Last updated
01/14/2016
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