MEDICARE: EMORY DIALYSIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013142843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMORY DIALYSIS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 116241
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-6241
Country	:	US
Telephone Number	:	229-387-3527
Fax Number	:	229-386-2149

Provider Business Practice Location Address
First Line	:	610 NORTHSIDE DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-6927
Country	:	US
Telephone Number	:	404-778-1050
Fax Number	:	404-892-1878

Authorized Official
Title or Position	:	DIRECTOR, MEDICAL STAFF SERVICES
Name	:	MR. ADAM J TRIBBETT
Credential	:	JD/MHA
Telephone Number	:	404-778-5294

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	08/15/2023

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