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