| NPI | 1962461038 |
|---|---|
| Doing Business As | MONROE JACKSON ST DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | THOMAS O USILTON Group Vice President 770-541-7922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment (Licence: LA 070) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2007-08-14 |