Provider Demographics
NPI:1922145788
Name:ATLANTA SOUTH NEPHROLOGY,PC
Entity Type:Organization
Organization Name:ATLANTA SOUTH NEPHROLOGY,PC
Other - Org Name:SOUTHEAST KIDNEY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUHAMMEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-761-0819
Mailing Address - Street 1:1275 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3433
Mailing Address - Country:US
Mailing Address - Phone:404-761-0819
Mailing Address - Fax:404-768-2313
Practice Address - Street 1:1275 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3433
Practice Address - Country:US
Practice Address - Phone:404-761-0819
Practice Address - Fax:047-682-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0441911AMedicaid
GA57785870AMedicaid
GA157444445AMedicaid
GA11BDCSKMedicare ID - Type Unspecified
GA0441911AMedicaid
GA39BDCKTMedicare ID - Type Unspecified
GAG61207Medicare UPIN
GA0C26017Medicare ID - Type Unspecified
GAC06246Medicare UPIN
GA57785870AMedicaid