Mableton Medical Enterprises Corp

Primary specialty

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

License

PENDING Issued in GA

Legal business name

MABLETON MEDICAL ENTERPRISES CORP

Doing business as

Mableton Dialysis

Practice address

1380 Veterans Memorial Hwy SW
Mableton, GA 30126-3112

Phone

(770) 485-1773

Fax

(770) 627-3202

NPI assigned

Jan 4, 2010

Organization subpart

Yes

Parent organization

MABLETON MEDICAL ENTERPRISES CORPAs reported in NPPES

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

Authorized official

Name

Ms. Olufunmilayo N/a Adejokun

Title

Ceo

Phone

(850) 728-2624

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mableton Dialysis Doing business as

Part of

Mableton Medical Enterprises Corp

Locations

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

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1699005223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5080 JOHNS CREEK CT",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300225186",
            "telephone_number": "850-728-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 VETERANS MEMORIAL HWY SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301263112",
            "telephone_number": "770-485-1773",
            "fax_number": "770-627-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MABLETON MEDICAL ENTERPRISES CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MABLETON MEDICAL ENTERPRISES CORP",
        "enumeration_date": "2010-01-04",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "ADEJOKUN",
        "authorized_official_first_name": "OLUFUNMILAYO",
        "authorized_official_middle_name": "N/A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-728-2624",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003104187A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mableton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luxottica of America Inc
• Silvia Ann Lynch, LCSW, LCADC
• Lynnica Healthcare Staffing, LLC
• Mabelton Enterprise
• Mableton Dental Inc
• Mac Healthcare Services LLC
• Marcus Samuel Maddox, SLP
• Danielle Madlock, APRN
• Mahant Dental LLC
• Bianca Sherise Marshall

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mableton, GA
• Providers in Mableton, 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 Dec 22, 2015; 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.