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General NPI Number Information
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NPI Number | 1063740793
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Entity Type | Organization
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Legal Business Name | MIDTOWN ATLANTA NEPHROLOGY PC
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 650 PEACHTREE ST NE SUITE 1650
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City | ATLANTA
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State | GA
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Zip | 30308-2310
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Country | US
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Telephone | 404-523-8810
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Fax | 404-523-8840
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Provider Business Mailing Address
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Address Line | 650 PEACHTREE ST NE SUITE 1650
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City | ATLANTA
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State | GA
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Zip | 30308-2310
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Country | US
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Telephone | 404-523-8810
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Fax | 404-523-8840
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Authorized Official
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Title or Position | CEO
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Name | FRITA MCCRAE FISHER
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Credential | M.D.
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Telephone | 404-523-8810
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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 | 060171
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License Number State | GA
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