Organization
DOUGLASVILLE NEPHROLOGY & HTN CLINIC
Active
Other names
Douglasville Nephrology
Organization subpart
No
Provider details
NPI number
Authorized official
DOREEN SMALLS (OFFICE MANAGER)
(770) 489-4978
Entity
Organization
Contact information
Practice address
6488 SPRING ST STE 100, DOUGLASVILLE, GA 30134-1895
(770) 489-4978
(770) 489-5279
Mailing address
6488 SPRING ST STE 100, DOUGLASVILLE, GA 30134-1895
(770) 489-4978
(770) 489-5279
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
40859
GA
207RN0300X
Nephrology Physician
Primary
40859
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006937877P
—
GA
05
—
00693877L
—
GA
05
—
00693877M
—
GA
05
—
00693877P
—
GA
05
—
00693877R
—
GA
05
—
00693877V
—
GA
05
—
00693877Z
—
GA
01
—
10038018
AMERIGROUP
GA
01
—
12085
COVENTRY
GA
01
—
303395
WELLCARE
GA
01
—
6443
KAISER PERMANENTE
GA
Enumeration date
01/05/2007
Last updated
02/14/2024
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