Organization
CRISP REGIONAL HOSPITAL, INC
Active
Other names
Crisp Regional Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN WADE WILDER (INTERNAL AUDITOR)
(229) 276-3100
Entity
Organization
Contact information
Practice address
902 N 7TH ST, CORDELE, GA 31015-3234
(229) 276-3100
(229) 276-3297
Mailing address
902 N 7TH ST, CORDELE, GA 31015-3234
(229) 271-9686
(229) 271-9689
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001001
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000431351A
—
GA
Enumeration date
03/08/2006
Last updated
06/12/2009
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