NPIMap

Organization Active NPI

Peachtree Nephrology PC

  • Nephrology Physician
  • Atlanta, GA
National Provider Identifier
1841565355
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
053746 Issued in GA
Legal business name
PEACHTREE NEPHROLOGY PC
Practice address
5673 Peachtree Dunwoody Rd NE
Suite 600
Atlanta, GA 30342-1731
Phone
(404) 410-3970
Fax
(404) 256-0040
NPI assigned
Mar 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

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

Authorized official

Name
Mrs. Anupama Gowda, MDNPI 1508947870
Title
Owner
Phone
(404) 410-3970

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 053746 GA Primary

Addresses

Primary practice location

5673 Peachtree Dunwoody Rd NE
Suite 600
Atlanta, GA 30342-1731

Mailing address

5673 Peachtree Dunwoody Rd NE
Suite 600
Atlanta, GA 30342-1731
Phone (404) 410-3970

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120816000919 GA Part B Supplier - Clinic/Group Practice 1557517968 Receives reassigned benefits from 6 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

3312 Chamblee Tucker Rd
Atlanta, GA 30341
Phone (770) 455-8725

1950 Riverside Pkwy
Ste 100
Lawrenceville, GA 30043
Phone (770) 322-9660

5673 Peachtree Dunwoody Rd
Ste 745
Sandy Springs, GA 30342
Phone (404) 410-3970

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/c063783f-c1a8-47a6-bf5b-d87d5981e7cb/

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1841565355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5673 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421731",
            "telephone_number": "404-410-3970",
            "fax_number": "404-256-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5673 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421731",
            "telephone_number": "404-410-3970",
            "fax_number": "404-256-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE NEPHROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "GOWDA",
        "authorized_official_first_name": "ANUPAMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-410-3970",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "053746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.