NRA-EATONTON GEORGIA LLC NPI 1225085004

NPI Information

NPI: 1225085004
Provider Name: NRA-EATONTON, GEORGIA, LLC

Doing Business As: PUTNAM DIALYSIS CENTER

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
130 HOSPITAL PERIMETER RD
EATONTON, GA
ZIP 31024
Phone: (706) 484-0123
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NRA-EATONTON, GEORGIA, LLC is an end-stage renal disease (esrd) treatment clinic center in Eatonton, GA. NRA-EATONTON, GEORGIA, LLC NPI is 1225085004. The provider is registered as an organization entity type.
The provider Is Doing Business As Putnam Dialysis Center.

The provider's business location address is:

130 HOSPITAL PERIMETER RD
EATONTON, GA
ZIP 31024-502
Phone: (706) 484-0123
Fax: (706) 484-0959

The provider's authorized official is Jon M. Sundock .
The authorized official title is Vice President and has the following contact phone number (615) 507-3307.

The enumeration date for this NPI number is 5/27/2006 and was last updated on 2/10/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD001102	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11D1049747	OTHER	GEORGIA	CLIA CERTIFICATE OF WAIVE
2	11-2650	MEDICARE OSCAR/CERTIFICATION	GEORGIA
3	028198194A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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