1982091294 NPI number — HARBIN CLINIC, LLC

Table of content: (NPI 1982091294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982091294 NPI number — HARBIN CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBIN CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARBIN CLINIC CALHOUN DIALYSIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982091294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 MARTHA BERRY BLVD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30165-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-295-5331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 CURTIS PKWY SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALHOUN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30701-3688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-238-8088
Provider Business Practice Location Address Fax Number:
706-235-3104
Provider Enumeration Date:
04/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
FRANKLIN
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
706-295-5331

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  ESRD001288 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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