Organization
KIDNEY INNOVATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE ADELL NICOLE WILLIAMS RN (CEO)
(912) 604-0280
Entity
Organization
Contact information
Practice address
575 GOVERNOR TREUTLEN CIR, POOLER, GA 31322-4504
(912) 604-0280
Mailing address
575 GOVERNOR TREUTLEN CIR, POOLER, GA 31322-4504
(912) 604-0280
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN288768
GEORGIA BOARD OF NURSING
GA
Enumeration date
02/23/2022
Last updated
02/23/2022
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