Healthcare Provider Details

I. General information

NPI: 1316712672
Provider Name (Legal Business Name): PREMIER NEPHROLOGY AND HYPERTENSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 POWDER SPRINGS ST BUILDING E, SUITE 29
MARIETTA GA
30064-3549
US

IV. Provider business mailing address

540 POWDER SPRINGS ST STE 29
MARIETTA GA
30064-3549
US

V. Phone/Fax

Practice location:
  • Phone: 770-470-3319
  • Fax:
Mailing address:
  • Phone: 770-470-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANDEEP JAGLAN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 770-296-9768