Provider Demographics
NPI:1659468056
Name:ATHENS KIDNEY CENTER, PC
Entity Type:Organization
Organization Name:ATHENS KIDNEY CENTER, PC
Other - Org Name:COMMERCE KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZUBUEZE
Authorized Official - Middle Name:AFAM
Authorized Official - Last Name:ADOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:706-543-6397
Mailing Address - Street 1:592 RIDGEWAY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1334
Mailing Address - Country:US
Mailing Address - Phone:706-335-6665
Mailing Address - Fax:706-335-2475
Practice Address - Street 1:592 RIDGEWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1334
Practice Address - Country:US
Practice Address - Phone:706-335-6665
Practice Address - Fax:706-335-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD000758261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
112818Medicare Oscar/Certification