Stockbridge Dialysis Clinic, LLC

Primary specialty

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

License

ESRD001247 Issued in GA

Legal business name

STOCKBRIDGE DIALYSIS CLINIC, LLC

Practice address

7444 Hannover Pkwy S
Suite 270
Stockbridge, GA 30281-9303

Phone

(678) 565-6228

Fax

(678) 565-6246

NPI assigned

Jun 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mohamad Moussa Kassem, MDNPI 1891726121

Title

President

Phone

(678) 565-6228

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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.

• Mohamad M Kassem, M.D.

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1891726121
  NPD (past) Authorized official

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811938277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3588 HIGHWAY 138 SE",
            "address_2": "PMB 344",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814171",
            "telephone_number": "770-565-6228",
            "fax_number": "770-565-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7444 HANNOVER PKWY S",
            "address_2": "SUITE 270",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819303",
            "telephone_number": "678-565-6228",
            "fax_number": "678-565-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKBRIDGE DIALYSIS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KASSEM",
        "authorized_official_first_name": "MOHAMAD",
        "authorized_official_middle_name": "MOUSSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-565-6228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Stith, PA-C
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• Stockbridge Dental Smiles LLC (Stockbridge Dental Smiles)
• Stockbridge Family Care Center
• Stockbridge Family Dental Group PC
• Stockbridge Family Dental Group PC
• Stockbridge Health & Wellness LLC
• Stockbridge Internal Medicine, PC

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