Provider Demographics
NPI:1730231382
Name:DAVITA DIALYSIS
Entity type:Organization
Organization Name:DAVITA DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:912-264-8657
Mailing Address - Street 1:53 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1862
Mailing Address - Country:US
Mailing Address - Phone:912-264-8657
Mailing Address - Fax:
Practice Address - Street 1:53 SCRANTON CONNECTOR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1862
Practice Address - Country:US
Practice Address - Phone:912-264-8657
Practice Address - Fax:912-265-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112514261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment