NCP McDonough, LLC

Primary specialty

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

Legal business name

NCP MCDONOUGH, LLC

Practice address

50 Kelly Rd
McDonough, GA 30253-6097

Phone

(305) 651-3261

Fax

(305) 651-2961

NPI assigned

Mar 23, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Gary John Booth

Title

Ceo

Phone

(305) 651-5458

Specialties & licenses 1

Addresses

Other names 1

• McDonough Dialysis Doing business as

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521763200000",
    "number": "1346744240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19559 NE 10TH AVE",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331793501",
            "telephone_number": "305-651-5458",
            "fax_number": "305-651-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 KELLY RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536097",
            "telephone_number": "305-651-3261",
            "fax_number": "305-651-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NCP MCDONOUGH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-23",
        "last_updated": "2018-03-23",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-651-5458",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McDonough Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dianna Narbon
• Mitzi I Nash, PT
• Nastazia Guy PLLC
• Ekta Nayee
• Ameena Nazir
• Camille D. Nelson, MD
• Destiny Danielle Nelson, NP
• Jennifer Merck Nelson, LMT
• Kelly Nicole Nelson
• New Behavioral Services LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in McDonough, GA
• Providers in McDonough, 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 Mar 23, 2018; 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.