Provider Demographics
NPI:1710296199
Name:ATHENS KIDNEY CENTER, P.C.
Entity Type:Organization
Organization Name:ATHENS KIDNEY CENTER, P.C.
Other - Org Name:LAKE HARTWELL KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AZUBUEZE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-543-6397
Mailing Address - Street 1:98 ARTHUR STREET
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-1804
Mailing Address - Country:US
Mailing Address - Phone:706-543-6397
Mailing Address - Fax:
Practice Address - Street 1:98 ARTHUR STREET
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1804
Practice Address - Country:US
Practice Address - Phone:706-543-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENS KIDNEY CENTER, P.C..
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-01
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136746AMedicaid
GA003136746AMedicaid