MEDICARE: NEPHRON CORPORATION

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104930023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHRON CORPORATION

Provider Business Mailing 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	:	770-513-2107

Provider Business Practice Location Address
First Line	:	710 BREEDLOVE DR
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2054
Country	:	US
Telephone Number	:	770-962-1231
Fax Number	:	770-513-2107

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. KIRTI K SHAH
Credential	:	M.D.
Telephone Number	:	770-962-1231

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	03/09/2009

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Directions to “NEPHRON CORPORATION ” Practice Location

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