Organization
CLASSIC CITY DIALYSIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMAD AHMED MD (PRESIDENT)
(706) 543-3130
Entity
Organization
Contact information
Practice address
2485 JEFFERSON ROAD, ATHENS, GA 30606-2100
(706) 543-3130
(706) 543-3215
Mailing address
2485 JEFFERSON ROAD, ATHENS, GA 30606-2100
(706) 543-3130
(706) 543-3215
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
080069004
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00783417
—
GA
01
—
045157
STATE LICENSE
GA
01
—
11443094883
NPI
—
01
—
66151
UPIN
—
Enumeration date
06/04/2009
Last updated
03/07/2023
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