Waycross Dialysis Facility, Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

WAYCROSS DIALYSIS FACILITY, INC

Practice address

220 Uvalda St
Waycross, GA 31501-4569

Phone

(912) 285-2487

Fax

(912) 287-1731

NPI assigned

Sep 29, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Padmanabh Maramreddy, M.D.

Title

Medical Director

Phone

(912) 285-2487

Specialties & licenses 1

Addresses

Other identifiers 4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Spurgeon William Clark III, M. D.

  • Ophthalmology Physician
  • Waycross, GA
  • NPI 1538334933
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1083601678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 UVALDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014569",
            "telephone_number": "912-285-2487",
            "fax_number": "912-287-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 UVALDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014569",
            "telephone_number": "912-285-2487",
            "fax_number": "912-287-1731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYCROSS DIALYSIS FACILITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "MARAMREDDY",
        "authorized_official_first_name": "PADMANABH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "912-285-2487",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000192772A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000183719D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51000007",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000408944A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deionna Berry Washington, LDO
• Cathleen M. Waters
• Melissa Waters, FNP-C
• Richard Watson, PHARMD
• Stephanie Hickman Watson, PHARMD
• Waycross Dialysis LLC (Waycross Dialysis)
• Waycross Family Pharmacy (Rivers and Associates LLC)
• Waycross Family Practice
• Waycross Orthopaedics, P.C.
• Waycross Urology Clinic PC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Waycross, GA
• Providers in Waycross, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.