Kidney Care Group Inc.

Primary specialty

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

License

ESRD001252 Issued in GA

Legal business name

KIDNEY CARE GROUP INC.

Doing business as

Loganville Dialysis

Practice address

3431 Highway 81
Loganville, GA 30052-9138

Phone

(678) 957-6299

Fax

(678) 639-1634

NPI assigned

Nov 1, 2006

Organization subpart

Yes

Parent organization

KIDNEY CARE GROUP INC.As reported in NPPES

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

Authorized official

Name

Ms. Saima Bashir

Title

Office Manager

Phone

(706) 227-4075

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Loganville Dialysis Doing business as

Part of

Kidney Care Group Inc

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1649357120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3431 HIGHWAY 81",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529138",
            "telephone_number": "678-957-6299",
            "fax_number": "678-639-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 HIGHWAY 81",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529138",
            "telephone_number": "678-957-6299",
            "fax_number": "678-639-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CARE GROUP INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDNEY CARE GROUP INC.",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "BASHIR",
        "authorized_official_first_name": "SAIMA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-227-4075",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "229313363A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loganville Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Loganville, GA
• Providers in Loganville, 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 Mar 23, 2012; 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.