GEORGIA NEPHROLOGY LLC NPI 1619919966

NPI Information

NPI: 1619919966
Provider Name: GEORGIA NEPHROLOGY, LLC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: SOUTH DEKALB DIALYSIS CENTER
Address: 2801 CANDLER RD
SUITE 203
DECATUR, GA
ZIP 30034
Phone: (404) 241-0402

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NPI Details

GEORGIA NEPHROLOGY, LLC is an end-stage renal disease (esrd) treatment clinic center in Decatur, GA. GEORGIA NEPHROLOGY, LLC NPI is 1619919966. The provider is registered as an organization entity type.
The provider Is Doing Business As South Dekalb Dialysis Center.

The provider's business location address is:

2801 CANDLER RD
SUITE 203
DECATUR, GA
ZIP 30034-423
Phone: (404) 241-0402
Fax: (404) 328-0232

The provider's authorized official is Andrew Dixon .
The authorized official title is Owner/ceo and has the following contact phone number (770) 981-0558.

The enumeration date for this NPI number is 6/12/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD001212	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00963168A/B	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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