MEDICARE: MIDTOWN ATLANTA NEPHROLOGY 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
1	207RN0300X	Nephrology Physician	060171	GA

General Provider Information

NPI Number	:	1063740793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN ATLANTA NEPHROLOGY PC

Provider Business Mailing Address
First Line	:	650 PEACHTREE ST NE
Second Line	:	SUITE 1650
City	:	ATLANTA
State	:	GA
Zip	:	30308-2310
Country	:	US
Telephone Number	:	404-523-8810
Fax Number	:	404-523-8840

Provider Business Practice Location Address
First Line	:	650 PEACHTREE ST NE
Second Line	:	SUITE 1650
City	:	ATLANTA
State	:	GA
Zip	:	30308-2310
Country	:	US
Telephone Number	:	404-523-8810
Fax Number	:	404-523-8840

Authorized Official
Title or Position	:	CEO
Name	:	FRITA MCCRAE FISHER
Credential	:	M.D.
Telephone Number	:	404-523-8810

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	11/18/2009

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