Provider Demographics
NPI:1740200278
Name:NEPHRON CORPORATION
Entity Type:Organization
Organization Name:NEPHRON CORPORATION
Other - Org Name:ATLANTA-EASTSIDE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-962-1231
Mailing Address - Street 1:605 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4315
Mailing Address - Country:US
Mailing Address - Phone:770-962-1231
Mailing Address - Fax:770-513-2107
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 140
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-962-1231
Practice Address - Fax:770-513-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-06-01
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
GA000682294BMedicaid
GA000682294AMedicaid
GA112614Medicare ID - Type Unspecified
GA000682294AMedicaid