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NPI Code Detail

MEDICARE: KIDNEY HYPERTENSION CLINIC, PC

MEDICARE: KIDNEY HYPERTENSION CLINIC, PC
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
1207RN0300XNephrology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CG3048OTHERGARAILROAD MEDICARE

General Provider Information

NPI Number : 1043327513
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDNEY HYPERTENSION CLINIC, PC
Provider Business Mailing Address
First Line : 605 OLD NORCROSS RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-4315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 605 OLD NORCROSS RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-4315
Country : US
Telephone Number : 770-962-1231
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : KIRTI K SHAH
Credential : M.D.
Telephone Number : 770-962-1231
Provider Enumeration Date : 08/23/2006
Last Update Date : 11/15/2007

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