Organization
DUBLIN KIDNEY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN K. ELLIS MD (CEO/OWNER)
(478) 353-3575
Entity
Organization
Contact information
Practice address
207 INDUSTRIAL BLVD, DUBLIN, GA 31021-2903
(478) 353-3575
Mailing address
PO BOX 6799, MACON, GA 31208-6799
(478) 353-3575
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
01
—
85-2550
CMS
GA
Enumeration date
04/02/2018
Last updated
11/08/2018
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