Provider Demographics
NPI:1225552391
Name:EMORY DIALYSIS, LLC
Entity Type:Organization
Organization Name:EMORY DIALYSIS, LLC
Other - Org Name:EMORY DIALYSIS AT NORTH DECATUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRCETOR, MEDICAL STAFF SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRIBBETT
Authorized Official - Suffix:
Authorized Official - Credentials:JD/MHA
Authorized Official - Phone:404-778-5294
Mailing Address - Street 1:PO BOX 116241
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6241
Mailing Address - Country:US
Mailing Address - Phone:229-386-5616
Mailing Address - Fax:229-386-2149
Practice Address - Street 1:2165 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5307
Practice Address - Country:US
Practice Address - Phone:404-251-2330
Practice Address - Fax:404-251-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment