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NPI Code Detail

MEDICARE: EMORY DIALYSIS, LLC

MEDICARE: EMORY DIALYSIS, LLC
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1477985992
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMORY DIALYSIS, LLC
Provider Business Mailing Address
First Line : PO BOX 7710
Second Line :
City : TIFTON
State : GA
Zip : 31793-7710
Country : US
Telephone Number : 229-387-3528
Fax Number : 229-386-2149
Provider Business Practice Location Address
First Line : 5673 PEACHTREE DUNWOODY RD STE 501
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2147
Country : US
Telephone Number : 404-778-8075
Fax Number : 678-843-6860
Authorized Official
Title or Position : CREDENTIALING COORD.
Name : MS. KIMBERLY AGEE-CLARK JOHNSON
Credential : MBA
Telephone Number : 229-387-3528
Provider Enumeration Date : 08/07/2013
Last Update Date : 02/09/2026

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Directions to “EMORY DIALYSIS, LLC ” Practice Location

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