Provider Demographics
NPI:1801223342
Name:ADVANCED KIDNEY CARE
Entity type:Organization
Organization Name:ADVANCED KIDNEY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SHALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-821-0338
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0847
Mailing Address - Country:US
Mailing Address - Phone:901-888-4144
Mailing Address - Fax:901-537-1894
Practice Address - Street 1:7710 WOLF RIVER CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1734
Practice Address - Country:US
Practice Address - Phone:901-888-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46930207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty