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General NPI Number Information
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NPI Number | 1568642544
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY & HYPERTENSION CLINIC, P.C.
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1136 CLEVELAND AVE SUITE 500
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City | EAST POINT
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State | GA
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Zip | 30344-3618
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Country | US
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Telephone | 404-669-9669
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Fax | 404-669-9668
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Provider Business Mailing Address
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Address Line | 1136 CLEVELAND AVE SUITE 500
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City | EAST POINT
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State | GA
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Zip | 30344-3618
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Country | US
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Telephone | 404-669-9669
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Fax | 404-669-9668
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Authorized Official
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Title or Position | CEO
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Name | BOB AGBOGU
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Credential | M.D.
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Telephone | 404-669-9669
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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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