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General NPI Number Information
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NPI Number | 1912484395
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Entity Type | Organization
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Legal Business Name | ATLANTA KIDNEY CARE LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 1462 MONTREAL RD STE 214
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City | TUCKER
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State | GA
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Zip | 30084-6931
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Country | US
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Telephone | 770-939-2020
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Fax | 770-939-6688
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Provider Business Mailing Address
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Address Line | PO BOX 467071
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City | ATLANTA
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State | GA
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Zip | 31146-7071
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Country | US
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Telephone | 770-939-2020
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Fax | 770-939-6688
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Authorized Official
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Title or Position | OWNER
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Name | HANIF BOGHANI
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Credential | MD
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Telephone | 404-933-2438
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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 | 047929
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License Number State |
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