Provider Demographics
NPI:1104872647
Name:HYPERTENSION & KIDNEY,PC
Entity type:Organization
Organization Name:HYPERTENSION & KIDNEY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NABILA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-513-3565
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1126
Mailing Address - Country:US
Mailing Address - Phone:770-513-3565
Mailing Address - Fax:770-513-1924
Practice Address - Street 1:134 S CLAYTON ST
Practice Address - Street 2:SUIT # 8
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5753
Practice Address - Country:US
Practice Address - Phone:770-513-3565
Practice Address - Fax:770-513-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051765207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA553623912AMedicaid
GA000967095EMedicaid
GA000967095GMedicaid
GA000967095CMedicaid
GA000967095JMedicaid
GA000967095KMedicaid
GA000967095BMedicaid
GA000967095HMedicaid
GA000967095FMedicaid
GA000967095IMedicaid
GA553623912AMedicaid
GA000967095HMedicaid
GA000967095IMedicaid
GA000967095KMedicaid
GA000967095EMedicaid