Organization
NRA-GRAY, GEORGIA, LLC
Active
Organization
NRA-GRAY, GEORGIA, LLC
Active
Other names
Gray 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
1002 BOULDER DR., GRAY, GA 31032
(615) 771-4400
(615) 771-4401
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
PENDING
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033165154
—
GA
01
—
CLIA
11D1061298
GA
Enumeration date
10/23/2006
Last updated
07/22/2015
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