1154373314 NPI number — CENTRAL GEORGIA KIDNEY SPECIALISTS, PC

Table of content: (NPI 1154373314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154373314 NPI number — CENTRAL GEORGIA KIDNEY SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL GEORGIA KIDNEY SPECIALISTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154373314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 2ND ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-6863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-745-4322
Provider Business Mailing Address Fax Number:
478-750-8789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-6863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-745-4322
Provider Business Practice Location Address Fax Number:
478-750-8789
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AKBAR
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
SOHAIL
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
478-745-4322

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000867325I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180599206M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770845851A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770845851C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000183598AN , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000867325W , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606AB , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606Y , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288034431B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000867325S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000867325V , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000884606W , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288034431A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288034431D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288034431E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000183598AE , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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