Organization
HARBIN CLINIC, LLC
Active
Organization
HARBIN CLINIC, LLC
Active
Other names
Harbin Clinic Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH FRANKLIN DAVIS MD (PRESIDENT & CEO)
(706) 295-5331
Entity
Organization
Contact information
Practice address
172 THREE RIVERS DR NE, ROME, GA 30161-4999
(706) 295-4641
(706) 295-5379
Mailing address
1825 MARTHA BERRY BLVD NW, ROME, GA 30165-1625
(706) 295-5331
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001250
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51704028-001
BCBS OF GEORGIA
GA
Enumeration date
08/10/2006
Last updated
08/22/2020
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