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General NPI Number Information
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NPI Number | 1255448965
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Entity Type | Organization
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Legal Business Name | GEORGIA KIDNEY CARE CENTER
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2920 METROPOLITAN PKWY SW
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City | ATLANTA
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State | GA
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Zip | 30315-7918
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Country | US
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Telephone | 678-641-1230
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Fax | 678-302-7309
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Provider Business Mailing Address
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Address Line | 2920 METROPOLITAN PKWY SW
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City | ATLANTA
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State | GA
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Zip | 30315-7918
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Country | US
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Telephone | 678-641-1230
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Fax | 678-302-7309
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WAINDEL BELIZAIRE
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Credential | MD
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Telephone | 678-641-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 052252
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License Number State | GA
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