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General NPI Number Information
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NPI Number | 1841230174
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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 | 06/07/2006
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 170 CAMDEN HILL RD SUITE F
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7418
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Country | US
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Telephone | 770-339-4225
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Fax | 770-339-4797
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Provider Business Mailing Address
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Address Line | 1627 COLE BLVD BLDG 182ND
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City | LAKEWOOD
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State | CO
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Zip | 80401-3315
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Country | US
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Telephone | 303-626-6000
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Fax | 866-352-3987
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Authorized Official
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Title or Position | VICE PRESIDENT & CONTROLLER
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Name | MR. ANTHONY E GABRIEL
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Credential |
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Telephone | 303-626-6000
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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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