NRA MONTICELLO GEORGIA LLC (NPI# 1245287358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245287358 |
| Entity Type | Organization |
| Organization Name | NRA MONTICELLO GEORGIA LLC |
| Other Organization Name | MONTICELLO DIALYSIS CENTER |
| Practice Address |
1393 Funderburg Dr Monticello GA 31064-6818 |
| Mailing Address |
1550 W. Mcewen Drive Suite 500 Franklin TN 37067-1731 |
| Practice Telephone | 7064681240 |
| Practice Fax Number | 7064685300 |
| Mailing Telephone | 6156611100 |
| Mailing Fax Number | 6155073300 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2015-07-22 |
| Authorized Official Name | MR. JON M. SUNDOCK (VICE PRESIDENT) |
| Authorized Official Telephone | 6155073307 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
ESRD001221 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CLIA CERTIFICATE OF WAIVE | 11D1049750 | 01 |
| GA | 419934334A | 05 |
| Other Name | Type Code |
|---|---|
| Monticello Dialysis Center | Doing Business As Name - Organization |
| Street Address |
1393 FUNDERBURG DR |
| City | MONTICELLO |
| State | GA |
| Zip Code | 31064-6818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497141576 | Dsi Macon, LLC | Clinic/Center | 1393 Funderburg Dr, Monticello, GA 31064-6818 | 2015-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568935757 | Neighborcare Pharmacy | Pharmacy | 3 Short St., Monticello, GA 31064 | 2019-01-10 |
| 1932563178 | Mary Catherine Sikes | Specialist/Technologist | 126 Hwy 212 West, Monticello, GA 31064 | 2016-04-13 |
| 1801018288 | Griswold Chiropractic | Chiropractor | 111 W. Washington St, Monticello, GA 31064 | 2007-05-03 |
| 1881733392 | Garrett Medical Supplies | Durable Medical Equipment & Medical Supplies | 126 Greene Street, Montilcello, GA 31064 | 2007-02-05 |
| 1629189212 | Stephen R Griswold | Chiropractor | 111 West Washington St, Monticello, GA 31064 | 2006-08-31 |
| 1144293457 | Jamie Alan Mitchell | Dentist | 458 W Washington St, Monticello, GA 31064 | 2006-02-08 |
| 1295738722 | Shannon T Barton | Family Medicine | 545 Venture Court, Monticello, GA 31064 | 2005-05-30 |
| 1093011314 | W Kenny Blake Md LLC | Family Medicine | 545 Venture Court, Monticello, GA 31064 | 2011-02-03 |
| 1811293137 | Shannon T. Barton Md LLC | Family Medicine | 545 Venture Court, Monticello, GA 31064 | 2011-02-03 |
| 1609859818 | Jasper County Emergency Medical Service | Ambulance | 185 Highway 212 W, Monticello, GA 31064-0000 | 2005-11-22 |
| Find all providers in zip 31064 | ||||
| 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 |
|---|---|---|---|---|
| 1770939241 | Bio-medical Applications of Kentucky, Inc. | Clinic/Center | 40 Walmart Plaza Dr, Monticello, KY 42633-7904 | 2016-05-13 |
| 1003915455 | Greater Lafayette Health Services | Clinic/Center | 1017 O Connor Blvd, Monticello, IN 47960-1600 | 2006-09-22 |
| 1285746180 | Jefferson County Dialysis Inc | Clinic/Center | 774 Jordan Dr, Monticello, AR 71655-5718 | 2006-08-31 |
| 1508802968 | Knickerbocker Dialysis Inc | Clinic/Center | 139 Forestburgh Rd, Monticello, NY 12701-2348 | 2006-06-22 |
| 1497141576 | Dsi Macon, LLC | Clinic/Center | 1393 Funderburg Dr, Monticello, GA 31064-6818 | 2015-04-15 |
| 1518057918 | Liberty Dialysis - Lafayette LLC | Clinic/Center | 810 S 6th St, Monticello, IN 47960-8201 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871190207 | Usrc Powder Springs Home LLC | Clinic/Center | 3721 New Macland Rd Ste 100b, Powder Springs, GA 30127-2000 | 2020-10-08 |
| 1083229280 | Bio- Medical Applications of Georgia, Inc. | Clinic/Center | 145 W Hendry St, Hinesville, GA 31313-3201 | 2020-09-14 |
| 1336759463 | Plattaz Dialysis, LLC | Clinic/Center | 100 Promenade Pkwy Ste C, Fayetteville, GA 30214-7735 | 2020-08-04 |
| 1174140743 | Home Dialysis Services Norcross LLC | Clinic/Center | 3780 Holcomb Bridge Rd Ste E, Norcross, GA 30092-4877 | 2020-06-30 |
| 1265058275 | Dialysis Care Center Pleasant Hill LLC | Clinic/Center | 1425 Georgia Ave Ste 102, Macon, GA 31201-6546 | 2020-06-25 |
| 1598389132 | Concerto Georgia LLC | Clinic/Center | 655 Exchange Cir Ste 100, Bethlehem, GA 30620-1767 | 2020-05-29 |
| 1629607098 | Rutledge Dialysis, LLC | Clinic/Center | 1719 New Hope Rd, Lawrenceville, GA 30045-6570 | 2020-04-07 |
| 1215562293 | Dialysis Clinic Inc | Clinic/Center | 1219 S. Martin Luther King Blvd., Americuse, GA 31719 | 2020-03-10 |
| 1659915882 | Filmore Dialysis, LLC | Clinic/Center | 4555 Atlanta Hwy Ste M, Loganville, GA 30052-2646 | 2019-10-31 |
| 1013562818 | Menca Dialysis, LLC | Clinic/Center | 3030 Headland Dr Sw Ste C, Atlanta, GA 30311-5435 | 2019-08-08 |
| Find all providers with the same taxonomy | ||||
| City | MONTICELLO |
| Zip Code | 31064 |
Please comment or provide details below to improve the information on NRA MONTICELLO GEORGIA LLC.
| 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.