Organization
NRA MIDTOWN MACON GEORGIA LLC
Active
Parent organization
NRA II, LLC
Other names
Midtown Macon Dialysis Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
NRA II, LLC
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
657 HEMLOCK ST, SUITE 100, MACON, GA 31201-8329
(478) 742-8001
(478) 742-3608
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1048766
CLIA CERTIFICATE OF WAIVE
GA
05
—
655442926A
—
GA
Enumeration date
05/27/2006
Last updated
07/22/2015
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