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	:	1972746204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMORY DIALYSIS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 7710
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31793-7710
Country	:	US
Telephone Number	:	229-387-3528
Fax Number	:	229-386-2149

Provider Business Practice Location Address
First Line	:	2726 CANDLER RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-1410
Country	:	US
Telephone Number	:	404-778-1025
Fax Number	:	404-243-0488

Authorized Official
Title or Position	:	CREDENTIALING COORD.
Name	:	MS. KIMBERLY AGEE-CLARK JOHNSON
Credential	:	MBA
Telephone Number	:	229-387-3528

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	02/09/2026

Similar Medicare Providers

1639423916 — MARGENA YVETTE STATEN-BRANCH NP-C
Practice Location Address:

2732 CANDLER RD
DECATUR, GA
30034-1410

Practice Phone: 470-444-3133
Practice Fax:

1790146124 — MRS. MAYA ALTONETTE BUTLER LPC, CCTP, NCC
Practice Location Address:

2732 CANDLER RD
DECATUR, GA
30034-1410

Practice Phone: 470-444-3133
Practice Fax: 470-276-4051

1962518316 — DR. HAROLD EARL MOORE JR. M.D.
Practice Location Address:

2764 CANDLER RD
DECATUR, GA
30034-1410

Practice Phone: 404-778-8600
Practice Fax: 404-778-8632

1912002635 — WILLIAM H BRYSON M.D.
Practice Location Address:

2764 CANDLER RD
DECATUR, GA
30034-1410

Practice Phone: 404-778-8600
Practice Fax:

1275639890 — ASHLEY E OWEN PH.D.
Practice Location Address:

2764 CANDLER RD
DECATUR, GA
30034-1410

Practice Phone: 404-778-8600
Practice Fax:

1366548158 — LAWRENCE J LUTZ MD
Practice Location Address:

2764 CANDLER RD
DECATUR, GA
30034-1410

Practice Phone: 404-778-8600
Practice Fax:

Directions to “EMORY DIALYSIS, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.