Provider Demographics
NPI:1083803472
Name:NEPHROLOGY INC
Entity Type:Organization
Organization Name:NEPHROLOGY INC
Other - Org Name:KIDNEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-304-3724
Mailing Address - Street 1:1425 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1323
Mailing Address - Country:US
Mailing Address - Phone:770-304-3724
Mailing Address - Fax:770-304-3726
Practice Address - Street 1:1425 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1323
Practice Address - Country:US
Practice Address - Phone:770-304-3724
Practice Address - Fax:770-304-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048905207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300044734CMedicaid
GAGRP4757Medicare PIN
GADG5164Medicare PIN