SOUTH FULTON DIALYSIS CENTER LLC (NPI# 1417016551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417016551 |
| Entity Type | Organization |
| Organization Name | SOUTH FULTON DIALYSIS CENTER LLC |
| Practice Address |
3268 Greenbriar Pkwy Sw Atlanta GA 30331-2604 |
| Mailing Address |
1151 Cleveland Avenue Suite A/b East Point GA 30344-3618 |
| Practice Telephone | 4049976700 |
| Practice Fax Number | 4049976710 |
| Mailing Telephone | 4046699669 |
| Mailing Fax Number | 4046696998 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2017-07-21 |
| Authorized Official Name | DR. BOB AGBOGU (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 4046699669 |
| 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 |
ESRD001133 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000823853B | 05 | |
| GA | 000823853A | 05 |
| Street Address |
3268 GREENBRIAR PKWY SW |
| City | ATLANTA |
| State | GA |
| Zip Code | 30331-2604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861001174 | Whitney Flemister | Social Worker | 3961 Princeton Lakes Way Sw, Atlanta, GA 30331 | 2020-07-23 |
| 1982237400 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 5829 Campbellton Road, S.w, Suite 110, Atlanta, GA 30331 | 2020-02-13 |
| 1295375558 | Drusilla Precious Cudjoe | Behavior Technician | 3800 Camp Creek Parkway Sw, Building 1400, Atlanta, GA 30331 | 2020-01-14 |
| 1497262778 | Champions Pharmacy | Pharmacy | 3886 Princeton Lakes Way Suite 180, Atlanta, GA 30331 | 2018-01-08 |
| 1033629779 | Carmen Ardoin | Counselor | 2636 Martin Luther King Jr. Drive, Suite 12, Atlanta, GA 30331 | 2017-10-09 |
| 1346759974 | Neva R Allison | Nurse Practitioner | 2611 Dayview Ln, Atlanta, GA 30331 | 2017-09-26 |
| 1538678255 | Natalie Mckay | Technician/Technologist | 3915 Cascade Rd, 220, Atlanta, GA 30331 | 2017-09-26 |
| 1700304268 | Tyrone Pipkin | Contractor | 415 Kendrick Terrace Sw, Atlanta, GA 30331 | 2017-09-05 |
| 1073031688 | Kristen Wooldridge | Pharmacist | 3695 Cascade Road, Atlanta, GA 30331 | 2017-09-04 |
| 1548704687 | Advance Pain Management | Health Maintenance Organization | 2950 Stone Hogan Road Connector, Atlanta, GA 30331 | 2016-12-08 |
| Find all providers in zip 30331 | ||||
| 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 |
|---|---|---|---|---|
| 1013562818 | Menca Dialysis, LLC | Clinic/Center | 3030 Headland Dr Sw Ste C, Atlanta, GA 30311-5435 | 2019-08-08 |
| 1619475217 | Bio-medical Applications of Georgia, Inc. | Clinic/Center | 1149 Cascade Pkwy Sw, Atlanta, GA 30311-3090 | 2018-01-29 |
| 1114463601 | Total Renal Care Inc | Clinic/Center | 2045 Donald Lee Hollowell Pkwy Nw, Atlanta, GA 30318-4701 | 2017-01-09 |
| 1477985992 | Emory Dialysis, LLC | Clinic/Center | 5673 Peachtree Dunwoody Rd, Ne, Suite 501, Atlanta, GA 30342 | 2013-08-07 |
| 1558709816 | Total Renal Care Inc | Clinic/Center | 2540 Flat Shoals Rd, Atlanta, GA 30349-4314 | 2013-06-10 |
| 1295005742 | Total Renal Care Inc | Clinic/Center | 540 Central Ave Sw, Atlanta, GA 30312-2735 | 2011-12-30 |
| 1821367830 | Total Renal Care Inc | Clinic/Center | 413b Loop 59, Atlanta, TX 75551-2015 | 2011-12-20 |
| 1013142843 | Emory Dialysis, LLC | Clinic/Center | 610 Northside Dr Nw, Atlanta, GA 30318-6927 | 2009-05-22 |
| 1851594329 | Renal Treatment Centers Mid Atlantic Inc | Clinic/Center | 3651 Bakers Ferry Rd Sw, Atlanta, GA 30331-3712 | 2007-06-11 |
| 1003974601 | Total Renal Care, Inc. | Clinic/Center | 448 Ralph Mcgill Blvd Ne, Atlanta, GA 30312-1217 | 2006-12-05 |
| Find all providers in ATLANTA | ||||
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| 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.