Provider Demographics
NPI:1992756894
Name:SOUTHWEST ATLANTA NEPHROLOGY, PC
Entity type:Organization
Organization Name:SOUTHWEST ATLANTA NEPHROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:404-696-7300
Mailing Address - Street 1:3620 M L KING JR DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-3711
Mailing Address - Country:US
Mailing Address - Phone:404-696-7300
Mailing Address - Fax:404-699-3514
Practice Address - Street 1:3620 M L KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-3711
Practice Address - Country:US
Practice Address - Phone:404-696-7300
Practice Address - Fax:404-699-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017375207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55000490AMedicaid
GA154733OtherBCBS
GAGRP482Medicare PIN
GA154733OtherBCBS