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General NPI Number Information
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NPI Number | 1407192172
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3570 GRANDVIEW PKWY STE 2
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City | BIRMINGHAM
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State | AL
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Zip | 35243-2064
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Country | US
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Telephone | 205-354-2100
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Fax | 866-343-6766
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Provider Business Mailing Address
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Address Line | 1840 E. RAY ROAD
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City | CHANDLER
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State | AZ
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Zip | 85225
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Country | US
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Telephone | 205-354-2100
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Fax | 866-343-6766
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | JENNIE PETERSON
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Credential |
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Telephone | 205-983-1120
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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 |
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License Number State |
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