Organization
ISD RENAL INC
Active
Other names
East Cobb Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
4880 LOWER ROSWELL RD, SUITE 770, MARIETTA, GA 30068-4375
(770) 321-0675
(770) 509-8283
Mailing address
5200 VIRGINIA WAY, LICENSURE AND CERTIFICATION DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003162182A
—
GA
Enumeration date
01/19/2015
Last updated
05/24/2022
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