Provider Demographics
NPI:1194914275
Name:DIALYSIS OF GOLDEN ISLES, LLC
Entity type:Organization
Organization Name:DIALYSIS OF GOLDEN ISLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHARKAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-271-2129
Mailing Address - Street 1:117 GEMINI CIR
Mailing Address - Street 2:SUTIE 418
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5874
Mailing Address - Country:US
Mailing Address - Phone:205-271-2129
Mailing Address - Fax:205-271-2139
Practice Address - Street 1:475 GATEWAY CENTER BLVD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:205-271-2129
Practice Address - Fax:205-271-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment