Organization
NRA-MILLEDGEVILLE GEORGIA LLC
Active
Other names
Oconee Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
421 N JEFFERSON ST NE, MILLEDGEVILLE, GA 31061-2920
(478) 451-0064
(478) 453-8043
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
ESRD001231
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1049749
CLIA CERTIFICATE OF WAIVE
GA
05
—
230307270A
—
GA
Enumeration date
05/26/2006
Last updated
07/22/2015
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