MEDICARE: ATLANTA SOUTH NEPHROLOGY,PC

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	261Q00000X	Clinic/Center
2	173000000X	Legal Medicine

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922145788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA SOUTH NEPHROLOGY,PC

Provider Business Mailing Address
First Line	:	1275 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3433
Country	:	US
Telephone Number	:	404-761-0819
Fax Number	:	404-768-2313

Provider Business Practice Location Address
First Line	:	1275 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3433
Country	:	US
Telephone Number	:	404-761-0819
Fax Number	:	47-682-3134

Authorized Official
Title or Position	:	CEO
Name	:	DR. MUHAMMED A MUHAMMEDI
Credential	:	MD
Telephone Number	:	404-761-0819

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	10/23/2019

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