NRA MACON GEORGIA LLC (NPI# 1033165154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033165154 |
| Entity Type | Organization |
| Organization Name | NRA MACON GEORGIA LLC |
| Other Organization Name | EISENHOWER PARKWAY DIALYSIS CENTER |
| Practice Address |
2525 2nd St Macon GA 31206-2223 |
| Mailing Address |
1550 W. Mcewen Drive Suite 500 Franklin TN 37067-1731 |
| Practice Telephone | 4787380420 |
| Practice Fax Number | 4787450460 |
| Mailing Telephone | 6156611100 |
| Mailing Fax Number | 6155073300 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2015-07-22 |
| Authorized Official Name | MR. JON M. SUNDOCK (VICE PRESIDENT) |
| Authorized Official Telephone | 6155073307 |
| Is Organization Subpart | Y |
| Parent Organization Name | RAI II, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
ESRD001230 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 813786518A | 05 | |
| GA | CLIA CERTIFICATE OF WAIVE | 11D1049748 | 01 |
| Other Name | Type Code |
|---|---|
| Eisenhower Parkway Dialysis Center | Doing Business As Name - Organization |
| Street Address |
2525 2ND ST |
| City | MACON |
| State | GA |
| Zip Code | 31206-2223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962493379 | Mufid Ata Othman | Internal Medicine | 2525 2nd St, Suite 150, Macon, GA 31206-2223 | 2005-11-03 |
| 1073999132 | Courtney Reeves | Nurse Practitioner | 2525 2nd St, Suite 150, Macon, GA 31206 | 2015-07-30 |
| 1255727327 | Dsi Macon, LLC | Clinic/Center | 2525 2nd St, Macon, GA 31206-2223 | 2015-04-15 |
| 1962708891 | Kidney Center of Central Georgia, LLC | Internal Medicine | 2525 2nd St, Suite 150, Macon, GA 31206-2223 | 2011-02-10 |
| 1467659854 | Franklin Enrique Fuenmayor-cardozo | Internal Medicine | 2525 2nd St, Ste 150, Macon, GA 31206-2223 | 2007-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992267892 | Andel Anthony Higgins | Family Medicine | 3780 Eisenhower Parkway, Macon, GA 31206 | 2019-04-01 |
| 1437651924 | Amanda Mckenzie | Clinic/Center | Us Renal Care 657 Hemlock Street, Macon, GA 31206 | 2018-03-01 |
| 1003337718 | Shantha Tyhessia Jones | Home Health | 2453 Shea Drive, Macon, GA 31206 | 2017-07-03 |
| 1043683527 | Autumn Anderson Lucas | Nurse Practitioner | 100 University Parkway, Macon, GA 31206 | 2015-11-05 |
| 1306273651 | Monique Whipple | Speech-Language Pathologist | 164 Summer Grove Lane, Macon, GA 31206 | 2013-10-02 |
| 1710956750 | Total Renal Care Inc | Clinic/Center | 2494 2nd St, Macon, GA 31206 | 2006-03-14 |
| 1396710828 | Ruth Macphie Hagemann | Counselor | 100 University Pkwy, Macon, GA 31206 | 2006-02-20 |
| 1609861129 | Rickey Harton Jr. | Optometrist | 3353 Mercer University Drive, Macon, GA 31206 | 2005-09-12 |
| 1104453711 | Lise Wendy Forestal | Student in an Organized Health Care Education/Training Program | 3780 Eisenhower Parkway, Macon, GA 31206 | 2020-03-24 |
| 1346702172 | Alayna Dukes | Family Medicine | 3780 Eisenhower Pkwy, Macon, GA 31206 | 2019-04-01 |
| Find all providers in zip 31206 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265058275 | Dialysis Care Center Pleasant Hill LLC | Clinic/Center | 1425 Georgia Ave Ste 102, Macon, GA 31201-6546 | 2020-06-25 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1396257010 | Leawood Dialysis LLC | Clinic/Center | 640 Martin Luther King Jr Blvd Ste 100, Macon, GA 31201-3297 | 2017-11-03 |
| 1699298794 | Macon Eastside Dialysis Center LLC | Clinic/Center | 640 North Ave Ste H, Macon, GA 31211-1455 | 2017-07-20 |
| 1881080950 | Dsi Macon, LLC | Clinic/Center | 657 Hemlock St Ste 100, Macon, GA 31201-8331 | 2015-04-15 |
| 1073910485 | Macon Southside Dialysis Center LLC | Clinic/Center | 2117 Eisenhower Pkwy, Macon, GA 31206-3185 | 2014-12-01 |
| 1891194783 | Dialysis Clinic Inc | Clinic/Center | 1203 N. Missouri St, Macon, MO 63552 | 2014-08-18 |
| 1962825844 | Georgia Kidney Institute,llc | Clinic/Center | 1625 Hardeman Ave, Macon, GA 31201-1417 | 2014-01-28 |
| 1598877300 | Bio-medical Applications of Georgia Inc | Clinic/Center | 2500 2nd St, Macon, GA 31206-2224 | 2006-08-31 |
| 1114039948 | Bio-medical Applications of Georgia Inc | Clinic/Center | 280 Clinton St, Macon, GA 31217-3954 | 2006-08-31 |
| Find all providers in MACON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.