Organization
NRA-HOGANSVILLE, GEORGIA, LLC
Active
Other names
Hogansville Dialysis Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
1002 WILLIAMS STREET, HOGANSVILLE, GA 30230
(706) 637-4028
(706) 637-4382
Mailing address
1550 W. MCEWEN DRIVE, SUITE 500, FRANKLIN, TN 37067-1731
(615) 661-1100
(615) 507-3300
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
PENDING
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1054263
CLIA CERT OF WAIVER
GA
Enumeration date
05/05/2006
Last updated
02/10/2011
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