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General NPI Number Information
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NPI Number | 1063070654
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Entity Type | Organization
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Legal Business Name | KIDNEY SPECIALISTS OF GEORGIA PC
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 575 PROFESSIONAL DR STE 290
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3347
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Country | US
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Telephone | 770-417-8170
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Fax | 770-417-8169
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Provider Business Mailing Address
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Address Line | PO BOX 3877
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City | JOLIET
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State | IL
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Zip | 60434-3877
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Country | US
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Telephone | 815-714-7155
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NNAMDI KELECHI NWAOHIRI
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Credential | MD
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Telephone | 443-616-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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