Provider Demographics
NPI:1770646747
Name:DIALYSIS ACCESS CENTER OF ATLANTA
Entity Type:Organization
Organization Name:DIALYSIS ACCESS CENTER OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-872-3655
Mailing Address - Street 1:1639 PIERCE DR
Mailing Address - Street 2:WMB 338
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:847-388-2032
Mailing Address - Fax:847-388-2025
Practice Address - Street 1:552 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1806
Practice Address - Country:US
Practice Address - Phone:404-872-3655
Practice Address - Fax:404-875-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty