Provider Demographics
NPI:1730815424
Name:FRESENIUS MEDICAL CARE CENTRAL LAWRENCEVILLE, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE CENTRAL LAWRENCEVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-632-3415
Mailing Address - Street 1:706 GRAYSON HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5736
Mailing Address - Country:US
Mailing Address - Phone:678-530-6650
Mailing Address - Fax:678-530-6660
Practice Address - Street 1:706 GRAYSON HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5736
Practice Address - Country:US
Practice Address - Phone:678-530-6650
Practice Address - Fax:678-530-6660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-26
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment