Provider Demographics
NPI:1083649552
Name:ATLANTA KIDNEY AND HYPERTENSION ASSOCIATES
Entity Type:Organization
Organization Name:ATLANTA KIDNEY AND HYPERTENSION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:EVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-247-1434
Mailing Address - Street 1:1810 MULKEY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1151
Mailing Address - Country:US
Mailing Address - Phone:770-732-8464
Mailing Address - Fax:770-732-8462
Practice Address - Street 1:1810 MULKEY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1151
Practice Address - Country:US
Practice Address - Phone:770-732-8464
Practice Address - Fax:770-732-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055949207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty