=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346060043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRESENIUS MEDICAL CARE SANDY SPRINGS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2024
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6160 PEACHTREE DUNWOODY RD STE A110
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-6038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-800-0209
-----------------------------------------------------
Fax | 770-391-2609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6160 PEACHTREE DUNWOODY RD STE A110
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-6038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | BARRY L BLANTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-699-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------