NPIMap

Organization Active NPI

Athens Kidney Center, PC

Doing business as Madison Kidney Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Madison, GA
National Provider Identifier
1871680264
Registry record updated Oct 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD000759 Issued in GA
Legal business name
ATHENS KIDNEY CENTER, PC
Doing business as
Madison Kidney Center
Practice address
1311 Atlanta Hwy
Madison, GA 30650-2069
Phone
(706) 343-1180
Fax
(706) 343-1183
NPI assigned
Oct 6, 2006
Last updated
Oct 15, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
ATHENS KIDNEY CENTER, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 2009

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

Authorized official

Name
Dr. Azubueze Afam Adogu, M.D., PH.D.
Title
President
Phone
(706) 543-6397

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ESRD000759 GA Primary

Addresses

Primary practice location

1311 Atlanta Hwy
Madison, GA 30650-2069

Mailing address

1311 Atlanta Hwy
Madison, GA 30650-2069
Phone (706) 343-1180

Other names 1

  • Madison Kidney Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090116000418 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9739127036 Practice locations: Madison, GA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Madison Kidney CenterCCN 112814
Ownership
Profit
Certified
May 14, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
12

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1099479Madison Kidney Center1311 Atlanta Highway Suite a, Madison, GA 30650Certificate of waiverMay 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Athens Kidney Center PC5 organizations share this tax ID, including this one
Part of
Athens Kidney Center PC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1311 Atlanta Hwy
Madison, GA 30650
Phone (706) 343-1180

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1871680264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 ATLANTA HWY",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306502069",
            "telephone_number": "706-343-1180",
            "fax_number": "706-343-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 ATLANTA HWY",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306502069",
            "telephone_number": "706-343-1180",
            "fax_number": "706-343-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS KIDNEY CENTER, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATHENS KIDNEY CENTER, PC",
        "enumeration_date": "2006-10-06",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "ADOGU",
        "authorized_official_first_name": "AZUBUEZE",
        "authorized_official_middle_name": "AFAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-543-6397",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD000759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.