Provider Demographics
NPI:1831286228
Name:ATHENS KIDNEY CENTER, PC
Entity Type:Organization
Organization Name:ATHENS KIDNEY CENTER, PC
Other - Org Name:
Other - Org Type:
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 1:1440 N CHASE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1850
Mailing Address - Country:US
Mailing Address - Phone:706-543-6397
Mailing Address - Fax:706-227-2116
Practice Address - Street 1:1440 N CHASE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1850
Practice Address - Country:US
Practice Address - Phone:706-543-6397
Practice Address - Fax:706-227-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD000999261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000731618EMedicaid
GA000731618DMedicaid
GA112674Medicare Oscar/Certification