Provider Demographics
NPI:1811338114
Name:BROOKHAVEN RENAL SYSTEMS, LLC
Entity type:Organization
Organization Name:BROOKHAVEN RENAL SYSTEMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKINTADE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-454-2519
Mailing Address - Street 1:1354 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3431
Mailing Address - Country:US
Mailing Address - Phone:404-454-2519
Mailing Address - Fax:
Practice Address - Street 1:2695 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3278
Practice Address - Country:US
Practice Address - Phone:404-454-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment