Provider Demographics
NPI:1063422723
Name:GEORGIA NEPHROLOGY, LLC
Entity type:Organization
Organization Name:GEORGIA NEPHROLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-645-7150
Mailing Address - Street 1:497 WINN WAY
Mailing Address - Street 2:SUITE A-210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1712
Mailing Address - Country:US
Mailing Address - Phone:404-294-7033
Mailing Address - Fax:404-296-4661
Practice Address - Street 1:497 WINN WAY STE A210
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-294-7033
Practice Address - Fax:404-296-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300027211AMedicaid