Louisville Dialysis Clinic-Peachtree LLC

Primary specialty

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

Legal business name

LOUISVILLE DIALYSIS CLINIC-PEACHTREE LLC

Practice address

1069 Peachtree St
Louisville, GA 30434-1558

Phone

(478) 625-9566

Fax

(478) 625-9567

NPI assigned

Dec 9, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Wilcox

Title

Cfo

Phone

(978) 922-3080

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1154729028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 PEACHTREE ST",
            "city": "LOUISVILLE",
            "state": "GA",
            "postal_code": "304341558",
            "telephone_number": "478-625-9566",
            "fax_number": "478-625-9567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 PEACHTREE ST",
            "city": "LOUISVILLE",
            "state": "GA",
            "postal_code": "304341558",
            "telephone_number": "478-625-9566",
            "fax_number": "478-625-9567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISVILLE DIALYSIS CLINIC-PEACHTREE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "978-922-3080",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "000814184A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bobbie W. Jones, RN
• Karen Butler, MD, LLC
• Peggy A Lampkin, PA
• Daja Andrea Lane
• Louisville Dialysis Clinic LLC
• Louisville Drug Company
• Gloria E. Machalk, RPH
• Teondra Shantay McGruder
• Sheila Teresa McKinnie
• Elizabeth Miller McNeely, PHARMD

• All providers in Louisville, GA
• 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 Mar 16, 2017; 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.