Provider Demographics
NPI:1558814459
Name:ATLANTA KIDNEY SPECIALISTS LLC
Entity Type:Organization
Organization Name:ATLANTA KIDNEY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SESHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-629-1900
Mailing Address - Street 1:130 MEDICAL WAY STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9088
Mailing Address - Country:US
Mailing Address - Phone:470-419-4000
Mailing Address - Fax:678-671-0700
Practice Address - Street 1:130 MEDICAL WAY STE D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9088
Practice Address - Country:US
Practice Address - Phone:470-419-4000
Practice Address - Fax:678-671-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003144035AMedicaid