1316180649 NPI number — EMORY DIALYSIS, LLC

Table of content: (NPI 1316180649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316180649 NPI number — EMORY DIALYSIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMORY DIALYSIS, LLC
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:
6
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:
1316180649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-6241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-387-3527
Provider Business Mailing Address Fax Number:
229-386-2149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CENTRE PKWY STE 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-8119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-778-1001
Provider Business Practice Location Address Fax Number:
404-649-2645
Provider Enumeration Date:
04/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TRIBBETT
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR, MEDICAL STAFF SERVICES
Authorized Official Telephone Number:
404-778-5294

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 560186658A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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