MEDICARE: ATHENS KIDNEY CENTER, 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	ESRD000759	GA

General Provider Information

NPI Number	:	1871680264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENS KIDNEY CENTER, PC

Provider Business Mailing Address
First Line	:	1311 ATLANTA HWY
Second Line	:
City	:	MADISON
State	:	GA
Zip	:	30650-2069
Country	:	US
Telephone Number	:	706-343-1180
Fax Number	:	706-343-1183

Provider Business Practice Location Address
First Line	:	1311 ATLANTA HWY
Second Line	:
City	:	MADISON
State	:	GA
Zip	:	30650-2069
Country	:	US
Telephone Number	:	706-343-1180
Fax Number	:	706-343-1183

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AZUBUEZE AFAM ADOGU
Credential	:	M.D., PH.D.
Telephone Number	:	706-543-6397

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/15/2009

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