Georgia Nephrology, LLC

Primary specialty

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

License

ESRD001212 Issued in GA

Legal business name

GEORGIA NEPHROLOGY, LLC

Doing business as

South Dekalb Dialysis Center

Practice address

2801 Candler Rd
Suite 203
Decatur, GA 30034-1423

Phone

(404) 241-0402

Fax

(404) 328-0232

NPI assigned

Jun 12, 2006

Organization subpart

No

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

Authorized official

Name

Andrew Dixon, MD

Title

Owner/Ceo

Phone

(770) 981-0558

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SOUTH DEKALB DIALYSIS CENTER Doing business as

Locations

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619919966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 CANDLER RD",
            "address_2": "SUITE 203",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341423",
            "telephone_number": "404-241-0402",
            "fax_number": "404-328-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 CANDLER RD",
            "address_2": "SUITE 203",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341423",
            "telephone_number": "404-241-0402",
            "fax_number": "404-328-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA NEPHROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "770-981-0558",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00963168A/B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH DEKALB DIALYSIS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Decatur, GA
• Providers in Decatur, 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.