Organization
ARA-VIDALIA CLINIC LLC
Active
Organization
ARA-VIDALIA CLINIC LLC
Active
Other names
NCA - Vidalia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER T FORD (PRESIDENT/CEO)
(978) 922-3080
Entity
Organization
Contact information
Practice address
906 E 1ST ST, VIDALIA, GA 30474-4207
(912) 538-8908
(912) 538-8909
Mailing address
66 CHERRY HILL DR, SUITE 200, BEVERLY, MA 01915-1054
(978) 922-3080
(978) 922-3085
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
—
00972529C
—
GA
Enumeration date
06/15/2006
Last updated
08/22/2020
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