Organization
SPALDING COUNTY DIALYSIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMAD MOUSSA KASSEM MD (PRESIDENT)
(770) 467-8116
Entity
Organization
Contact information
Practice address
744 S 8TH ST STE 100, GRIFFIN, GA 30224-4827
(770) 467-8116
(770) 467-8795
Mailing address
744 S 8TH ST STE 100, GRIFFIN, GA 30224-4827
(770) 467-8116
(770) 467-8795
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001194
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00946613A
—
GA
Enumeration date
06/08/2006
Last updated
12/01/2023
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