Healthcare Provider Details

I. General information

NPI: 1063422723
Provider Name (Legal Business Name): GEORGIA NEPHROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 WINN WAY STE A210
DECATUR GA
30030
US

IV. Provider business mailing address

497 WINN WAY SUITE A-210
DECATUR GA
30030-1712
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-7033
  • Fax: 404-296-4661
Mailing address:
  • Phone: 404-294-7033
  • Fax: 404-296-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN MURO
Title or Position: PHYSICIAN/PROVIDER
Credential: M.D.
Phone: 404-645-7150