Putnam Dialysis LLC

Primary specialty

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

Legal business name

PUTNAM DIALYSIS LLC

Practice address

301 South Jefferson Ave
Suite 101
Eatonton, GA 31024

Phone

(706) 485-1724

Fax

(706) 485-7043

NPI assigned

Jan 18, 2018

Last updated

Feb 26, 2025By 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

Mr. Mufid A Othman, MD

Title

Ceo

Phone

(478) 254-7353

Specialties & licenses 1

Addresses

Listed as

Putnam Dialysis LLCCCN 852548

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Aug 14, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

Listed as

Renviva Dialysis Center of North GeorgiaCCN 852609

Ownership

Profit

Certified

Sep 3, 2024

Medicare certification status

ActiveFrom the Provider of Services file

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.

• Ihab Zaki Zaggout, MD

  • Nephrology Physician
  • Macon, GA
  • NPI 1487774303
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Salvatore Chillemi, MD

  • Nephrology Physician
  • Marietta, GA
  • NPI 1285839431

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1952819419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SOUTH JEFFERSON AVE",
            "address_2": "SUITE 101",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "31024",
            "telephone_number": "706-485-1724",
            "fax_number": "706-485-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SOUTH JEFFERSON AVE",
            "address_2": "SUITE 101",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "31024",
            "telephone_number": "706-485-1724",
            "fax_number": "706-485-7043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "OTHMAN",
        "authorized_official_first_name": "MUFID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-254-7353",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pure Heart Behavioral Therapy, LLC
• Putnam County Board of Education
• Putnam County Board of Health
• Putnam County Commissioners
• Putnam County Health Care LLC (Eatonton Health and Rehabilitation)
• Putnam General Hospital Authority (Putnam General Hospital)
• Putnam General Hospital Authority (Putnam General Hospital)
• Putnam General Hospital Authority (Putnam General Hospital)
• Putnam General Hospital Authority (Putnam General Hospital Physicians Group)
• Putnam General Hospital Authority (Putnam General Hospital)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Eatonton, GA
• Providers in Eatonton, 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 Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.