Southern Nephrology Clinic LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

057606 Issued in GA

Legal business name

SOUTHERN NEPHROLOGY CLINIC LLC

Practice address

8954 Hospital Dr
Building C. Suite 115
Douglasville, GA 30134-2272

Phone

(770) 577-4825

Fax

(770) 577-4827

NPI assigned

Aug 7, 2007

Organization subpart

No

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

Authorized official

Name

Rafiq M El Hammali, M.D.NPI 1396965547

Title

Owner/Manager

Phone

(770) 577-4825

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.

• Rafiq M. El Hammali, MD

  • Nephrology Physician
  • Douglasville, GA
  • NPI 1396965547
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1912198581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 385",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301330385",
            "telephone_number": "770-577-4825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8954 HOSPITAL DR",
            "address_2": "BUILDING C. SUITE 115",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342272",
            "telephone_number": "770-577-4825",
            "fax_number": "770-577-4827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN NEPHROLOGY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "EL HAMMALI",
        "authorized_official_first_name": "RAFIQ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "770-577-4825",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "057606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Nephrology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.