MEDICARE: TRINITY DIALYSIS CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245227560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY DIALYSIS CLINIC INC

Provider Business Mailing Address
First Line	:	1354 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3431
Country	:	US
Telephone Number	:	404-763-0405
Fax Number	:	404-763-4223

Provider Business Practice Location Address
First Line	:	1354 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3431
Country	:	US
Telephone Number	:	404-763-0405
Fax Number	:	404-763-4223

Authorized Official
Title or Position	:	CEO
Name	:	ADETOLA AKINTADE
Credential	:
Telephone Number	:	404-763-0405

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	12/30/2024

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