Healthcare Provider Details

I. General information

NPI: 1114162369
Provider Name (Legal Business Name): VAINER & VAINER NEPHROLOGY CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 ALPHARETTA HWY STE 650A
ROSWELL GA
30076-4943
US

IV. Provider business mailing address

5456 PEACHTREE BLVD STE 302
ATLANTA GA
30341-2235
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-4347
  • Fax: 404-255-3353
Mailing address:
  • Phone: 404-255-4347
  • Fax: 404-255-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036627
License Number StateGA

VIII. Authorized Official

Name: FAYE K MOORE
Title or Position: BILLING MGR
Credential:
Phone: 478-951-9420