Provider Demographics
NPI:1508061151
Name:HYPERTENSION AND KIDNEY ASSOCIATES OF MIDDLE GEORGIA, LLC
Entity Type:Organization
Organization Name:HYPERTENSION AND KIDNEY ASSOCIATES OF MIDDLE GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-333-3612
Mailing Address - Street 1:105 TOMMY STALNAKER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8956
Mailing Address - Country:US
Mailing Address - Phone:478-333-3612
Mailing Address - Fax:478-333-3631
Practice Address - Street 1:105 TOMMY STALNAKER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8956
Practice Address - Country:US
Practice Address - Phone:478-333-3612
Practice Address - Fax:478-333-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050597207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA148116723ABMedicaid
GA148116723OMedicaid
GA148116723QMedicaid
GA148116723NMedicaid
GU000968613OMedicaid
GU000968613QMedicaid
GA000968613ZMedicaid
GA000968613PMedicaid
GAGRP8078Medicare PIN
GU000968613QMedicaid
GA000968613PMedicaid
GA148116723NMedicaid
GA148116723ABMedicaid