Organization
NCP MCDONOUGH, LLC
Active
Other names
McDonough Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY JOHN BOOTH (CEO)
(305) 651-5458
Entity
Organization
Contact information
Practice address
50 KELLY RD, MCDONOUGH, GA 30253-6097
(305) 651-3261
(305) 651-2961
Mailing address
19559 NE 10TH AVE, NORTH MIAMI BEACH, FL 33179-3501
(305) 651-5458
(305) 651-2961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
03/23/2018
Last updated
03/23/2018
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