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General NPI Number Information
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NPI Number | 1558814459
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Entity Type | Organization
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Legal Business Name | ATLANTA KIDNEY SPECIALISTS LLC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 130 MEDICAL WAY STE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9088
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Country | US
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Telephone | 470-419-4000
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Fax | 678-671-0700
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Provider Business Mailing Address
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Address Line | 130 MEDICAL WAY STE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9088
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Country | US
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Telephone | 470-419-4000
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Fax | 678-671-0700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJ SESHAN
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Credential | M.D.
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Telephone | 470-629-1900
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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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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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