=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235718008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUBURBAN KIDNEY CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2021
-----------------------------------------------------
Last Update Date | 04/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6330 PRIMROSE HILL CT # 106
-----------------------------------------------------
City | PEACHTREE CORNERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-4544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-520-4361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6330 PRIMROSE HILL CT STE 106
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-4544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-649-3900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NEPHROLOGIST
-----------------------------------------------------
Name | DR. NIRAV PARIKH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 470-649-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------