Pedernales Dialysis LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Colquitt, GA
NPI 1013310150 · NPPES record last updated Apr 25, 2019
Key facts
- NPI
- 1013310150
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- PEDERNALES DIALYSIS LLC
- Practice address
- 213 Delores St
Colquitt, GA 39837-3528 - Phone
- (229) 758-1985
- Fax
- (229) 758-2555
- NPI assigned
- Oct 3, 2014
- Organization subpart
- No
Authorized official
- Name
- James K Hilger
- Title
- Chief Accounting Officer
- Phone
- (253) 733-4500
Member of 2
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | GA | Yes |
Addresses
Primary practice location
213 Delores St
Colquitt, GA 39837-3528
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003158694A | Medicaid | GA |
Other names
- Miller Dialysis
Other providers in Colquitt, GA
- Sherria Maria Norwood
- Stephanie Brock Nunnery
- Olufunmilayo Abidemi Onobrakpeya
- Open Arms Hospice, Inc.
- Nakeisha Anne Otto-Stewart
- Stephanie Davis Phillips
- Ansley Poague
- Roy Richard Reardon
- Rxdirect
- Amy Askew Sanderson
All providers in Colquitt, GA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.