Organization
SOUTH ATLANTA KIDNEY CARE DIALYSIS
Active
Organization
SOUTH ATLANTA KIDNEY CARE DIALYSIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAINDEL BELIZAIRE D.O (PHYSICIAN-MEDICAL DIRECTOR)
(770) 994-0171
Entity
Organization
Contact information
Practice address
2221 PEACHTREE RD NE, SUITE D 195, ATLANTA, GA 30309-1148
(770) 994-0171
(770) 507-4190
Mailing address
195 UPPER RIVERDALE RD SUITE A, RIVERDALE, GA 30274
(770) 994-0171
(770) 507-4190
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
052252
GA
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
112780
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
626468445A
—
GA
Enumeration date
07/16/2006
Last updated
07/13/2008
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