Provider Demographics
NPI:1275668394
Name:NORTH GEORGIA NEPHROLOGY CONSULTANTS,LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA NEPHROLOGY CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-227-4075
Mailing Address - Street 1:5105 JEFFERSON RD
Mailing Address - Street 2:SUITE # B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1701
Mailing Address - Country:US
Mailing Address - Phone:706-227-4075
Mailing Address - Fax:706-227-4086
Practice Address - Street 1:5105 JEFFERSON ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1720
Practice Address - Country:US
Practice Address - Phone:706-227-4075
Practice Address - Fax:706-227-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050865207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52834554005OtherBCBS
GAP00076801OtherMEDICARE RAIL ROAD
GA000935789FMedicaid
GA000935789AMedicaid
GA10035054OtherAMERIGROUP
GA3100152OtherUNITED HEALTH
GA5628203OtherAETNA PPO
GA2917383OtherAETNA HMO
GAGRP5128OtherMEDICARE GROUP NUMBER
GA000935789DMedicaid
GA000935789EMedicaid
GA460374361AOtherGBHC
GAP00076801OtherMEDICARE RAIL ROAD