Provider Demographics
NPI:1821468711
Name:KIDNEY CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:KIDNEY CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:EL HAMMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-577-4825
Mailing Address - Street 1:6095 PROFESSIONAL PKWY STE B205
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6095 PROFESSIONAL PKWY STE B205
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5611
Practice Address - Country:US
Practice Address - Phone:770-577-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty