NPIMap

Organization Active NPI

South Atlanta Kidney Care Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Atlanta, GA
National Provider Identifier
1891712766
Registry record updated Jul 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
112780 Issued in GA
Legal business name
SOUTH ATLANTA KIDNEY CARE DIALYSIS
Practice address
2221 Peachtree Rd NE
Suite D 195
Atlanta, GA 30309-1148
Phone
(770) 994-0171
Fax
(770) 507-4190
NPI assigned
Jul 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2008

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

Authorized official

Name
Waindel Belizaire, D.O
Title
Physician-Medical Director
Phone
(770) 994-0171

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 052252 GA
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 112780 GA Primary

Addresses

Primary practice location

2221 Peachtree Rd NE
Suite D 195
Atlanta, GA 30309-1148

Mailing address

195 Upper Riverdale Rd Suite a
Riverdale, GA 30274
Phone (770) 994-0171

Other identifiers 1

IdentifierTypeStateIssuer
626468445AMedicaidGA

National Provider Directory

National Provider Directory

Locations

195 Upper Riverdale Rd SW
Ste A
Riverdale, GA 30274
Phone (770) 994-0171

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215907200000",
    "number": "1891712766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 UPPER RIVERDALE RD SUITE A",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "30274",
            "telephone_number": "770-994-0171",
            "fax_number": "770-507-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 PEACHTREE RD NE",
            "address_2": "SUITE D 195",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091148",
            "telephone_number": "770-994-0171",
            "fax_number": "770-507-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTA KIDNEY CARE DIALYSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2008-07-13",
        "status": "A",
        "authorized_official_last_name": "BELIZAIRE",
        "authorized_official_first_name": "WAINDEL",
        "authorized_official_title_or_position": "PHYSICIAN-MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-994-0171",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "052252",
            "primary": false
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "112780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626468445A",
            "state": "GA"
        }
    ],
    "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 Jul 13, 2008; 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.