Provider Demographics
NPI:1114162369
Name:VAINER & VAINER NEPHROLOGY CONSULTANTS, INC
Entity Type:Organization
Organization Name:VAINER & VAINER NEPHROLOGY CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, AA
Authorized Official - Phone:404-255-4347
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 380
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1714
Mailing Address - Country:US
Mailing Address - Phone:404-255-4347
Mailing Address - Fax:404-255-9438
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 380
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1714
Practice Address - Country:US
Practice Address - Phone:404-255-4347
Practice Address - Fax:404-255-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF59871Medicare UPIN
GAF55780Medicare UPIN
GAH09936Medicare UPIN