NPIMap

Organization Active NPI

Peach State Nephrology

  • Nephrology Physician
  • Griffin, GA
National Provider Identifier
1679773774
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PEACH STATE NEPHROLOGY
Practice address
619 S 8TH St Ste 100
Griffin, GA 30224-4260
Phone
(678) 248-2899
NPI assigned
Jul 18, 2007
Last updated
Jun 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Authorized official

Name
Dr. Sonu Gupta Singh, MDNPI 1366477424
Title
Owner
Phone
(678) 371-4281

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

619 S 8TH St Ste 100
Griffin, GA 30224-4260

Mailing address

619 S 8TH St Ste 100
Griffin, GA 30224-4260
Phone (678) 248-2899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080219000726 GA Part B Supplier - Clinic/Group Practice 7315021029 Receives reassigned benefits from 5 practitioners
Practice locations: Griffin, GA; Stockbridge, GA; Jackson, GA

National Provider Directory

National Provider Directory
Tax ID family
Peach State Nephrology Inc2 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.

Locations

604A S 8th St
Griffin, GA 30224
Phone (770) 227-1999

619 S 8th St
Ste 100
Griffin, GA 30224
Phone (678) 248-2899

Practitioners & affiliated clinicians

Practitioners 7

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": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1679773774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 S 8TH ST STE 100",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244260",
            "telephone_number": "678-248-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S 8TH ST STE 100",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244260",
            "telephone_number": "678-248-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE NEPHROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "SINGH",
        "authorized_official_first_name": "SONU",
        "authorized_official_middle_name": "GUPTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-371-4281",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Griffin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.