Organization
DIALYSIS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONOVAN SCHULTZ (PRESIDENT)
(615) 327-3061
Entity
Organization
Contact information
Practice address
1611 21ST COURT, PHENIX CITY, AL 36867
(334) 448-4840
(334) 448-4430
Mailing address
1611 21ST COURT, PHENIX CITY, AL 36867
(334) 448-4840
(334) 448-4430
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
07985
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053249301A
—
GA
05
—
DIA2598D
—
AL
Enumeration date
07/20/2006
Last updated
10/04/2023
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