Provider Demographics
NPI:1063740793
Name:MIDTOWN ATLANTA NEPHROLOGY PC
Entity type:Organization
Organization Name:MIDTOWN ATLANTA NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRITA
Authorized Official - Middle Name:MCCRAE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-523-8810
Mailing Address - Street 1:650 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2310
Mailing Address - Country:US
Mailing Address - Phone:404-523-8810
Mailing Address - Fax:404-523-8840
Practice Address - Street 1:650 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1650
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2310
Practice Address - Country:US
Practice Address - Phone:404-523-8810
Practice Address - Fax:404-523-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060171207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty