Southern Renal Group, Inc.

Primary specialty

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

License

001254 Issued in GA

Legal business name

SOUTHERN RENAL GROUP, INC.

Doing business as

Lindbergh Dialysis Center

Practice address

2695 Buford Hwy NE
Suite 108
Atlanta, GA 30324-3278

Phone

(404) 315-0605

Fax

(404) 315-0607

NPI assigned

May 11, 2006

Last updated

Aug 22, 2020By 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

Mr. Benedict Ehirim

Title

President

Phone

(404) 315-0605

Specialties & licenses 1

Addresses

Other names 1

• Lindbergh Dialysis Center Doing business as

Locations

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376593319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 BUFORD HWY NE",
            "address_2": "SUITE 108",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243278",
            "telephone_number": "404-315-0605",
            "fax_number": "404-315-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2695 BUFORD HWY NE",
            "address_2": "SUITE 108",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243278",
            "telephone_number": "404-315-0605",
            "fax_number": "404-315-0607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN RENAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EHIRIM",
        "authorized_official_first_name": "BENEDICT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-315-0605",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "001254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lindbergh Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Atlanta, GA
• Providers in Atlanta, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.