Healthcare Provider Details

I. General information

NPI: 1992756894
Provider Name (Legal Business Name): SOUTHWEST ATLANTA NEPHROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 M L KING JR DR SW
ATLANTA GA
30331-3711
US

IV. Provider business mailing address

3620 M L KING JR DR SW
ATLANTA GA
30331-3711
US

V. Phone/Fax

Practice location:
  • Phone: 404-696-7300
  • Fax: 404-699-3514
Mailing address:
  • Phone: 404-696-7300
  • Fax: 404-699-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number017375
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM H CLEVELAND II
Title or Position: PRESIDENT
Credential: M.D.
Phone: 404-696-7300