Provider Demographics
NPI:1871680264
Name:ATHENS KIDNEY CENTER, PC
Entity Type:Organization
Organization Name:ATHENS KIDNEY CENTER, PC
Other - Org Name:MADISON KIDNEY CENTER
Other - Org Type:Doing Business As
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 1:1311 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2069
Mailing Address - Country:US
Mailing Address - Phone:706-343-1180
Mailing Address - Fax:706-343-1183
Practice Address - Street 1:1311 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2069
Practice Address - Country:US
Practice Address - Phone:706-343-1180
Practice Address - Fax:706-343-1183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENS KIDNEY CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD000759261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112814Medicare Oscar/Certification