NPIMap

Organization Active NPI

Emory Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Atlanta, GA
National Provider Identifier
1013142843
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
EMORY DIALYSIS, LLC
Practice address
610 Northside Dr NW
Atlanta, GA 30318-6927
Phone
(404) 778-1050
Fax
(404) 892-1878
NPI assigned
May 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Agee-Clark Johnson, MBA
Title
Credentialing Coord.
Phone
(229) 387-3528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

610 Northside Dr NW
Atlanta, GA 30318-6927

Mailing address

PO Box 7710
Tifton, GA 31793-7710
Phone (229) 387-3528

Other identifiers 1

IdentifierTypeStateIssuer
943588192AMedicaidGA

Other names 1

  • Emory Dialysis at Northside Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091216000289 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9931249364 1 other NPI on this enrollment
Practice locations: Atlanta, GA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Emory Dialysis at NorthsideCCN 112824
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Feb 3, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Other
Dialysis stations
41

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1107416Emory Dialysis at Northside610 Northside Drive NW, Atlanta, GA 30318Certificate of waiverNov 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Emory Dialysis5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770595200000",
    "number": "1013142843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7710",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317937710",
            "telephone_number": "229-387-3528",
            "fax_number": "229-386-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 NORTHSIDE DR NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303186927",
            "telephone_number": "404-778-1050",
            "fax_number": "404-892-1878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMORY DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-22",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "AGEE-CLARK",
        "authorized_official_title_or_position": "CREDENTIALING COORD.",
        "authorized_official_telephone_number": "229-387-3528",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "943588192A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emory Dialysis at Northside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.