Organization
FIDELITY HOME DIALYSIS CORPORATION
Active
Organization
FIDELITY HOME DIALYSIS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE FICKLIN (ADMINISTRATOR)
(501) 217-3888
Entity
Organization
Contact information
Practice address
1230 JOHNSON FERRY PL STE H30, MARIETTA, GA 30068-2058
(678) 742-8563
(678) 742-8178
Mailing address
1230 JOHNSON FERRY PL STE H30, MARIETTA, GA 30068-2058
(678) 742-8563
(678) 742-8178
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042593
MEDICARE
AR
Enumeration date
02/04/2015
Last updated
05/31/2022
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