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General NPI Number Information
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NPI Number | 1811338114
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN RENAL SYSTEMS, LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 2695 BUFORD HWY NE
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City | ATLANTA
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State | GA
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Zip | 30324-3278
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Country | US
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Telephone | 404-454-2519
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Fax |
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Provider Business Mailing Address
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Address Line | 1354 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-3431
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Country | US
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Telephone | 404-454-2519
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. MICHAEL A AKINTADE
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Credential | R.N
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Telephone | 404-454-2519
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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 |
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License Number State |
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