Provider Demographics
NPI:1316712672
Name:PREMIER NEPHROLOGY AND HYPERTENSION LLC
Entity type:Organization
Organization Name:PREMIER NEPHROLOGY AND HYPERTENSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-296-9768
Mailing Address - Street 1:540 POWDER SPRINGS ST STE 29
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3549
Mailing Address - Country:US
Mailing Address - Phone:770-470-3319
Mailing Address - Fax:
Practice Address - Street 1:540 POWDER SPRINGS ST
Practice Address - Street 2:BUILDING E, SUITE 29
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3549
Practice Address - Country:US
Practice Address - Phone:770-470-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty