SOUTH FULTON DIALYSIS CENTER LLC – End-Stage Renal Disease (ESRD) Treatment Clinic/Center, NPI 1417016551

SOUTH FULTON DIALYSIS CENTER LLC is a healthcare provider. based in Atlanta, Georgia. specializing in End-Stage Renal Disease (ESRD) Treatment Clinic/Center. The organization holds a License No. ESRD001133 (GA). The NPI Number for SOUTH FULTON DIALYSIS CENTER LLC is 1417016551

Main info

Organization
Name
SOUTH FULTON DIALYSIS CENTER LLC
NPI
1417016551
Phone
(404) 997-6700
Address
3268 GREENBRIAR PKWY SW
Authorized Official
DR. BOB AGBOGU MEDICAL DIRECTOR
Enumeration Date
6 December 2006
Last Update Date
21 July 2017
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

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Provider Addresses for SOUTH FULTON DIALYSIS CENTER LLC

  • 3268, Greenbriar Parkway Southwest, Ben Hill, Atlanta, Fulton County, Georgia, 30331, United States

    ATLANTA, GA 303312604

    Phone: (404) 997-6700

    Fax: (404) 997-6710

    Type: Location

  • 1151, East Cleveland Avenue, East Point, Fulton County, Georgia, 30344, United States

    SUITE A/B

    EAST POINT, GA 303443618

    Phone: (404) 669-9669

    Fax: (404) 669-6998

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2006-03-01

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2025-06-30 (347 days ago).

Enrollment records

1

Earliest due date

2025-06-30

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20060301000103OEnd-Stage Renal Disease Facility (Esrd)GA2025-06-30

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30331)

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Reviews

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Frequently asked questions

What is the registry number for SOUTH FULTON DIALYSIS CENTER LLC?
The registry entry for SOUTH FULTON DIALYSIS CENTER LLC shows NPI 1417016551.
Is SOUTH FULTON DIALYSIS CENTER LLC's NPI status active today?
Active status means SOUTH FULTON DIALYSIS CENTER LLC's NPI record is not deactivated in the public file.
How should patients interpret SOUTH FULTON DIALYSIS CENTER LLC's specialty?
The extract shows End-Stage Renal Disease (ESRD) Treatment Clinic/Center for SOUTH FULTON DIALYSIS CENTER LLC. Clinical services aligned with this taxonomy classification.
What geographic area is tied to SOUTH FULTON DIALYSIS CENTER LLC?
SOUTH FULTON DIALYSIS CENTER LLC is associated with Atlanta, Georgia in the same public data insurers reference.
Who maintains SOUTH FULTON DIALYSIS CENTER LLC's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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