NPIMap

Organization Active NPI

Southwest Atlanta Nephrology, PC

  • Nephrology Physician
  • Atlanta, GA
National Provider Identifier
1992756894
Registry record updated Sep 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
017375 Issued in GA
Legal business name
SOUTHWEST ATLANTA NEPHROLOGY, PC
Practice address
3620 M L King Jr Dr SW
Atlanta, GA 30331-3711
Phone
(404) 696-7300
Fax
(404) 699-3514
NPI assigned
May 15, 2006
Last updated
Sep 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2010

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

Authorized official

Name
Dr. William H Cleveland II, M.D.NPI 1588607493
Title
President
Phone
(404) 696-7300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 017375 GA Primary

Addresses

Primary practice location

3620 M L King Jr Dr SW
Atlanta, GA 30331-3711

Mailing address

3620 M L King Jr Dr SW
Atlanta, GA 30331-3711
Phone (404) 696-7300

Other identifiers 2

IdentifierTypeStateIssuer
55000490AMedicaidGA
154733OtherGABCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000750 GA Part B Supplier - Clinic/Group Practice 2062315088 Receives reassigned benefits from 11 practitioners
Practice locations: East Point, GA; Decatur, GA; Atlanta, GA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

121 Linden Ave NE
Ste 102
Atlanta, GA 30308
Phone (404) 815-7217

2460 Wesley Chapel Rd
Decatur, GA 30035

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16547/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285545600000",
    "number": "1992756894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 M L KING JR DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303313711",
            "telephone_number": "404-696-7300",
            "fax_number": "404-699-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 M L KING JR DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303313711",
            "telephone_number": "404-696-7300",
            "fax_number": "404-699-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST ATLANTA NEPHROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2010-09-27",
        "status": "A",
        "authorized_official_last_name": "CLEVELAND",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-696-7300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "017375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55000490A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "154733",
            "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 Sep 27, 2010; 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.