Provider Demographics
NPI:1184955791
Name:NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUMJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-4813
Mailing Address - Street 1:P.O. BOX 15238
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1938
Mailing Address - Country:US
Mailing Address - Phone:912-354-4813
Mailing Address - Fax:912-354-7569
Practice Address - Street 1:16 OKATIE CTR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7533
Practice Address - Country:US
Practice Address - Phone:912-354-4813
Practice Address - Fax:912-354-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7157Medicare PIN