NPIMap

Organization Active NPI

Georgia Kidney Clinic LLC

  • Nephrology Physician
  • Buford, GA
National Provider Identifier
1417664616
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
GEORGIA KIDNEY CLINIC LLC
Practice address
3382 Grace Farm LN
Buford, GA 30519
Phone
(404) 731-6033
NPI assigned
Oct 28, 2022
Last updated
Oct 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Authorized official

Name
Riyadh R Al-Rubaye, MDNPI 1639433741
Title
Owner
Phone
(047) 316-0334

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

3382 Grace Farm LN
Buford, GA 30519

Mailing address

2725 Hamilton Mill Rd Ste 500
Buford, GA 30519-6010
Phone (404) 731-6033

National Provider Directory

National Provider Directory
Tax ID family
Georgia Kidney Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1417664616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 HAMILTON MILL RD STE 500",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305196010",
            "telephone_number": "404-731-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3382 GRACE FARM LN",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30519",
            "telephone_number": "404-731-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA KIDNEY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-24",
        "status": "A",
        "authorized_official_last_name": "AL-RUBAYE",
        "authorized_official_first_name": "RIYADH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "047-316-0334",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.