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General NPI Number Information
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NPI Number | 1205748035
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Entity Type | Organization
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Legal Business Name | SOUTH EAST KIDNEY HOME DIALYSIS
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 310 PHILIP BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8700
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Country | US
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Telephone | 404-410-3970
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Fax |
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Provider Business Mailing Address
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Address Line | 310 PHILIP BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8700
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Country | US
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Telephone | 404-410-3970
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Fax |
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. TARIK LALWANI
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Credential | MD
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Telephone | 404-410-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number |
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License Number State |
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