Provider Demographics
NPI:1053416925
Name:NORTH GEORGIA KIDNEY SPECIALISTS, LLC
Entity type:Organization
Organization Name:NORTH GEORGIA KIDNEY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOLO
Authorized Official - Middle Name:S
Authorized Official - Last Name:GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-528-9788
Mailing Address - Street 1:880 CANTON RD NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7283
Mailing Address - Country:US
Mailing Address - Phone:770-528-9788
Mailing Address - Fax:770-420-2229
Practice Address - Street 1:880 CANTON RD NE
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7283
Practice Address - Country:US
Practice Address - Phone:770-528-9788
Practice Address - Fax:770-420-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036745207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1285688283OtherMUHAMMAD YASSER JABRI, M.D. INDIVIDUAL NPI #
GA233167541AMedicaid
GA555189352AMedicaid
GADD6106OtherMEDICARE RAILROAD GROUP #
GA00691182ABMedicaid
GA282117409AMedicaid
GA000960726FMedicaid
GA1275520793OtherGALLEGO INDIVIDUAL NPI
GA000960726FMedicaid
GADD6106OtherMEDICARE RAILROAD GROUP #
GAH39848Medicare UPIN
GAI67498Medicare UPIN
GA202I393080Medicare PIN
GAGRP7186Medicare PIN
GA00691182ABMedicaid
GAG11649Medicare UPIN
GA5511I130044Medicare PIN