Healthcare Provider Details

I. General information

NPI: 1376455451
Provider Name (Legal Business Name): KIDNEY CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD STE 3400
CUMMING GA
30041-8223
US

IV. Provider business mailing address

15555 NE 68TH CT
REDMOND WA
98052-4829
US

V. Phone/Fax

Practice location:
  • Phone: 205-552-9221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KHUSHLEEN JAGGI
Title or Position: OWNER
Credential:
Phone: 205-552-9221