Organization Active NPI

Atlanta Kidney and Hypertension Associates

  • Nephrology Physician
  • Austell, GA
National Provider Identifier
1083649552
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
055949 Issued in GA
Legal business name
ATLANTA KIDNEY AND HYPERTENSION ASSOCIATES
Practice address
1810 Mulkey Rd
Suite 103
Austell, GA 30106-1151
Phone
(770) 732-8464
Fax
(770) 732-8462
NPI assigned
Jul 12, 2006
Last updated
Apr 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Authorized official

Name
Traci Evett
Title
Billing Coordinator
Phone
(678) 247-1434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 055949 GA Primary

Addresses

Primary practice location

1810 Mulkey Rd
Suite 103
Austell, GA 30106-1151

Mailing address

1810 Mulkey Rd
Suite 103
Austell, GA 30106-1151
Phone (770) 732-8464

Other practice location 1

1899 Lake Rd Ste 111
Hiram, GA 30141-2292
Phone (770) 732-8464

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060801000197 GA Part B Supplier - Clinic/Group Practice 6608889043 Receives reassigned benefits from 4 practitioners
Practice locations: Hiram, GA; Austell, GA

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
11D1053467Atlanta Kidney and Hypertension Associates1810 Mulkey Rd, Ste 103, Austell, GA 30106Provider-performed microscopyApr 1, 2028
11D1095730Atlanta Kidney and Hypertension Associates1899 Lake Road Suite 111, Hiram, GA 30141Provider-performed microscopyFeb 16, 2027

National Provider Directory

National Provider Directory

Locations

1810 Mulkey Rd
Ste 103
Austell, GA 30106
Phone (770) 732-8464

1899 Lake Rd
Ste 111
Hiram, GA 30141
Phone (770) 732-8464

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3666/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1083649552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 MULKEY RD",
            "address_2": "SUITE 103",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061151",
            "telephone_number": "770-732-8464",
            "fax_number": "770-732-8462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 MULKEY RD",
            "address_2": "SUITE 103",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061151",
            "telephone_number": "770-732-8464",
            "fax_number": "770-732-8462"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1899 Lake Rd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301412292",
            "country_code": "US",
            "telephone_number": "770-732-8464",
            "fax_number": "770-732-8462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATLANTA KIDNEY AND HYPERTENSION ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "EVETT",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "678-247-1434"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "055949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.