Healthcare Provider Details

I. General information

NPI: 1922145788
Provider Name (Legal Business Name): ATLANTA SOUTH NEPHROLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 CLEVELAND AVE
EAST POINT GA
30344-3433
US

IV. Provider business mailing address

1275 CLEVELAND AVE
EAST POINT GA
30344-3433
US

V. Phone/Fax

Practice location:
  • Phone: 404-761-0819
  • Fax: 47-682-3134
Mailing address:
  • Phone: 404-761-0819
  • Fax: 404-768-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MUHAMMED A MUHAMMEDI
Title or Position: CEO
Credential: MD
Phone: 404-761-0819