DRG FAYETTE PLLC NPI 1891978953

NPI Information

  • NPI: 1891978953
  • Provider Name: DRG FAYETTE PLLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Other Name: DIVERSIFIED RENAL GROUP FAYETTE, PLLC
  • Address: 225 COMMUNITY DRIVE
    OFF HWY 61
    FAYETTE, MS
    ZIP 39069
  • Phone: (601) 786-6676

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NPI Details

DRG FAYETTE PLLC is an end-stage renal disease (esrd) treatment clinic center in Fayette, MS. DRG FAYETTE PLLC NPI is 1891978953. The provider is registered as an organization entity type.
The provider Other Name Is Diversified Renal Group Fayette, Pllc.

The provider's business location address is:

225 COMMUNITY DRIVE
OFF HWY 61
FAYETTE, MS
ZIP 39069
Phone: (601) 786-6676
Fax: (601) 786-6678

The provider's authorized official is Tunde Olutade .
The authorized official title is Member and has the following contact phone number (601) 899-3340.

The enumeration date for this NPI number is 12/12/2007 and was last updated on 1/15/2008.

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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentMISSISSIPPIYes

What is NPI?

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This page was last updated on: 11/21/2025

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