Organization
ELLENWOOD DIALYSIS CENTER, LLC
Active
Organization
ELLENWOOD DIALYSIS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMAD KASSEM MD (OWNER/MEDICAL DIRECTOR)
(678) 392-6198
Entity
Organization
Contact information
Practice address
209 BENNETTE BLVD, ELLENWOOD, GA 30294-2785
(770) 996-6446
(678) 833-3981
Mailing address
3580 CAMERON PKWY, STOCKBRIDGE, GA 30281-7816
(770) 996-6446
(678) 833-3981
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
09/14/2011
Last updated
09/14/2011
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