South Henry Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

SOUTH HENRY DIALYSIS LLC

Practice address

1095 Henry Parkway Connector
McDonough, GA 30253-6669

Phone

(678) 565-6228

Fax

(770) 996-6279

NPI assigned

Feb 11, 2008

Last updated

Dec 9, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sheila Dixon

Title

Controller

Phone

(678) 565-6228

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

South Henry Dialysis CenterCCN 112799

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Jul 2, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

16

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

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Mohamad M Kassem, M.D.

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1891726121
  NPD (past)

Affiliated clinicians 1

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

• Mohamad M Kassem, M.D.

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1891726121

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1235317454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 CAMERON PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817816",
            "telephone_number": "678-565-6228",
            "fax_number": "770-996-6279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 HENRY PARKWAY CONNECTOR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536669",
            "telephone_number": "678-565-6228",
            "fax_number": "770-996-6279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HENRY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "678-565-6228"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in McDonough, GA
• Providers in McDonough, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.