Organization
STOCKBRIDGE DIALYSIS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMAD MOUSSA KASSEM MD (PRESIDENT)
(678) 565-6228
Entity
Organization
Contact information
Practice address
7444 HANNOVER PKWY S, SUITE 270, STOCKBRIDGE, GA 30281-9303
(678) 565-6228
(678) 565-6246
Mailing address
3588 HIGHWAY 138 SE, PMB 344, STOCKBRIDGE, GA 30281-4171
(770) 565-6228
(770) 565-6246
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001247
GA
Other
Enumeration date
06/09/2006
Last updated
08/22/2020
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