NPIMap

Organization Active NPI

Fulton Dekalb Hospital Authority

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Atlanta, GA
National Provider Identifier
1982804993
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
060069 Issued in GA
Legal business name
FULTON DEKALB HOSPITAL AUTHORITY
Practice address
80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031
Phone
(404) 616-6695
Fax
(404) 616-3297
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Mr. David C Makkers Sr.
Title
Director of Managed Care
Phone
(404) 616-6695

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 060069 GA Primary

Addresses

Primary practice location

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031

Mailing address

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3050
Phone (404) 616-6695

Other identifiers 1

IdentifierTypeStateIssuer
00410825AMedicaidGA

Other names 1

  • GRADY HEALTH SYSTEM Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1982804993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 JESSE HILL JR DR SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033050",
            "telephone_number": "404-616-6695",
            "fax_number": "404-616-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 JESSE HILL JR DR SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033031",
            "telephone_number": "404-616-6695",
            "fax_number": "404-616-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULTON DEKALB HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "MAKKERS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "404-616-6695",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "060069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00410825A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRADY HEALTH SYSTEM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 9, 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.