Provider Demographics
NPI:1558473371
Name:STONE MOUNTAIN DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:STONE MOUNTAIN DIALYSIS CENTER, LLC
Other - Org Name:FRESENIUS MEDICAL CARE STONE MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:5723 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3425
Mailing Address - Country:US
Mailing Address - Phone:678-836-0251
Mailing Address - Fax:678-836-0260
Practice Address - Street 1:5723 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3425
Practice Address - Country:US
Practice Address - Phone:678-836-0251
Practice Address - Fax:678-836-0260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-10-16
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
112705Medicare Oscar/Certification