Nra Monticello Georgia LLC

Primary specialty

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

License

ESRD001221 Issued in GA

Legal business name

NRA MONTICELLO GEORGIA LLC

Doing business as

Monticello Dialysis Center

Practice address

1393 Funderburg Dr
Monticello, GA 31064-6818

Phone

(706) 468-1240

Fax

(706) 468-5300

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jon M. Sundock

Title

Vice President

Phone

(615) 507-3307

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Monticello Dialysis Center Doing business as

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437523200000",
    "number": "1245287358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 W. MCEWEN DRIVE",
            "address_2": "SUITE 500",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370671731",
            "telephone_number": "615-661-1100",
            "fax_number": "615-507-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1393 FUNDERBURG DR",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310646818",
            "telephone_number": "706-468-1240",
            "fax_number": "706-468-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA MONTICELLO GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2015-07-22",
        "status": "A",
        "authorized_official_last_name": "SUNDOCK",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-507-3307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE OF WAIVE",
            "identifier": "11D1049750",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "419934334A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monticello Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Stacey Rowe Schuessler, RPH
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• Mary Catherine Sikes, MED, ATC, LAT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Monticello, GA
• Providers in Monticello, 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 Jul 22, 2015; 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.