Provider Demographics
NPI:1316180649
Name:EMORY DIALYSIS, LLC
Entity Type:Organization
Organization Name:EMORY DIALYSIS, LLC
Other - Org Name:EMORY DIALYSIS AT GREENBRIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, 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:229-387-3527
Mailing Address - Fax:229-386-2149
Practice Address - Street 1:2841 GREENBRIAR PKWY SW
Practice Address - Street 2:X126
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2620
Practice Address - Country:US
Practice Address - Phone:404-778-1001
Practice Address - Fax:404-649-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA560186658AMedicaid
GA11-2823Medicare PIN