Provider Demographics
NPI:1649357120
Name:KIDNEY CARE GROUP INC.
Entity type:Organization
Organization Name:KIDNEY CARE GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-227-4075
Mailing Address - Street 1:3431 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-9138
Mailing Address - Country:US
Mailing Address - Phone:678-957-6299
Mailing Address - Fax:678-639-1634
Practice Address - Street 1:3431 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-9138
Practice Address - Country:US
Practice Address - Phone:678-957-6299
Practice Address - Fax:678-639-1634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDNEY CARE GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAESRD001252261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA229313363AMedicaid
GAG33639Medicare UPIN
GA112755Medicare ID - Type Unspecified