Provider Demographics
NPI:1487293700
Name:FRESENIUS MEDICAL CARE NORTHEAST ATLANTA, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE NORTHEAST ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:4455 STONE MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4525
Mailing Address - Country:US
Mailing Address - Phone:678-344-1586
Mailing Address - Fax:678-344-1588
Practice Address - Street 1:4455 STONE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4525
Practice Address - Country:US
Practice Address - Phone:678-344-1586
Practice Address - Fax:678-344-1588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment