Provider Demographics
NPI:1831562958
Name:ATLANTA KIDNEY CARE LLC
Entity type:Organization
Organization Name:ATLANTA KIDNEY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9362
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1714
Mailing Address - Country:US
Mailing Address - Phone:404-255-1030
Mailing Address - Fax:678-843-6619
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 260
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1714
Practice Address - Country:US
Practice Address - Phone:404-255-1030
Practice Address - Fax:678-843-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181580AMedicaid