Organization
HEPHZIBAH DIALYSIS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
2516 TOBACCO RD, HEPHZIBAH, GA 30815-7099
(706) 790-9314
(706) 790-9315
Mailing address
2516 TOBACCO RD, HEPHZIBAH, GA 30815-7099
(706) 790-9314
(706) 790-9315
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
05
—
003143995A
—
GA
Enumeration date
07/10/2013
Last updated
01/13/2023
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