Kidneyspa East Atlanta Dialysis, LLC

Primary specialty

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

Legal business name

KIDNEYSPA EAST ATLANTA DIALYSIS, LLC

Practice address

2375 Metropolitan Pkwy SW
Atlanta, GA 30315-6223

Phone

(305) 329-2900

NPI assigned

Mar 1, 2022

Organization subpart

No

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

Authorized official

Name

Juan M Cuellar, M.D.

Title

Ceo

Phone

(305) 329-2900

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1972259737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 NW 12TH AVE APT 508",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331282206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 METROPOLITAN PKWY SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303156223",
            "telephone_number": "305-329-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEYSPA EAST ATLANTA DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "CUELLAR",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-329-2900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "HIE",
            "affiliation": "N",
            "address_1": "2375 Metropolitan Pkwy SW",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303156223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Casandra M Kidd, DRPH
• Charlene Byssainthe Kidd, LCSW
• Jordan Kidd, CPHT
• Shane Kidd
• Kidgroups, LLC
• Kids on the Move, LLC
• Kids Time Pediatrics of Perimeter, LLC
• Kids-N-Motion ABA LLC
• Kids-N-Motion, Inc
• Kyle Michael Kidwell, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Atlanta, GA
• Providers in Atlanta, 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 Mar 1, 2022; 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.