Provider Demographics
NPI:1184858094
Name:METRO NEPHROLOGY, INC
Entity Type:Organization
Organization Name:METRO NEPHROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-663-8766
Mailing Address - Street 1:11810 NORTHFALL LN STE 1202
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7975
Mailing Address - Country:US
Mailing Address - Phone:770-663-8761
Mailing Address - Fax:770-663-8767
Practice Address - Street 1:11810 NORTHFALL LN STE 1202
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7975
Practice Address - Country:US
Practice Address - Phone:770-663-8761
Practice Address - Fax:770-663-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13543207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13543OtherOCCUPATIONAL TAX CERTIFICATE, CITY OF ROSWELL