Organization
LAGRANGE TROUP COUNTY HOSPITAL AUTHORITY
Active
Organization
LAGRANGE TROUP COUNTY HOSPITAL AUTHORITY
Active
Other names
West Georgia Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD N FULKS (PRESIDENT CEO)
(706) 845-3244
Entity
Organization
Contact information
Practice address
140 GLENN BASS ROAD, LAGRANGE, GA 30240-5809
(706) 845-3282
(706) 845-3474
Mailing address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 845-3728
(706) 845-3902
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
05
—
00409186A
—
GA
Enumeration date
02/13/2006
Last updated
11/05/2007
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