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EASTSIDE PREMIER NEPHROLOGY & HYPERTENSION PC NPI 1104048651


NPI Information

NPI: 1104048651
Provider Name: EASTSIDE PREMIER NEPHROLOGY & HYPERTENSION PC
Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

CLIA Number: 11D0991710

Address:
1612 MILSTEAD RD NE
SUITE A
CONYERS, GA
ZIP 30012
Phone: (678) 413-3261
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EASTSIDE PREMIER NEPHROLOGY & HYPERTENSION PC is a nephrology internal medicine in Conyers, GA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. EASTSIDE PREMIER NEPHROLOGY & HYPERTENSION PC NPI is 1104048651. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1612 MILSTEAD RD NE
SUITE A
CONYERS, GA
ZIP 30012-738
Phone: (678) 413-3261
Fax: (678) 413-3580

The provider's authorized official is Oladapo Falase .
The authorized official title is Office Manager and has the following contact phone number (678) 413-3261.

The CLIA number assigned to this NPI record is 11D0991710 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/3/2007 and was last updated on 3/22/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RN0300XInternal MedicineNephrology044714GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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