Organization
NEPHROLOGY CENTER OF SOUTH AUGUSTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVETTE MYERS RN (FACILITY ADMINISTRATOR)
(706) 790-8300
Entity
Organization
Contact information
Practice address
1631 GORDON HWY STE 1-B, AUGUSTA, GA 30906-2221
(706) 790-8300
(706) 790-9944
Mailing address
1631 GORDON HWY STE 1-B, AUGUSTA, GA 30906-2221
(706) 790-8300
(706) 790-9944
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
12414140
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00409802A
—
GA
01
—
348887
WELLCARE
GA
Enumeration date
05/11/2007
Last updated
08/14/2008
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