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ELLENWOOD DIALYSIS CENTER, LLC
NPI 1235411406
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Ellenwood, GA

Active since September 14, 2011CLIA 11D2033813 · Waiver
3/5
Overall Rating
209 BENNETTE BLVD, ELLENWOOD, GA 30294(770) 996-6446(678) 833-3981 Get Directions Write a Review

NPPES record last updated: September 14, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ellenwood Dialysis Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELLENWOOD DIALYSIS CENTER, LLC (NPI 1235411406) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Ellenwood, Georgia and active in the NPI registry since September 2011. The organization holds a CLIA Waiver certificate valid through December 11, 2027 and lists Mohamad Kassem, Owner/medical Director, as its authorized official.

NPPES Registry Identity

NPI1235411406
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameELLENWOOD DIALYSIS CENTER, LLC
Location Address209 BENNETTE BLVDEllenwood, GA 30294-2785
Mailing Address3580 Cameron PkwyStockbridge, GA 30281-7816 · (770) 996-6446 · Fax (678) 833-3981
Phone(770) 996-6446
Fax(678) 833-3981
Organization SubpartNo
Authorized OfficialMohamad KassemOwner/medical Director · (678) 392-6198
Enumeration DateSeptember 14, 2011
✔ NPI 1235411406 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
209 BENNETTE BLVD, Ellenwood, GA 30294
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2033813

Ellenwood Dialysis Center, LLC · Ellenwood, GA
Active · expires Dec 11, 2027
CLIA Number11D2033813
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateDecember 12, 2025
Certificate Expiration DateDecember 11, 2027
Laboratory DirectorKassem M. Mohamad
Laboratory Phone(770) 996-6446
Laboratory LocationEllenwood Dialysis Center, LLC209 Bennette Blvd, Ellenwood, GA 30294
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for Ellenwood Dialysis Center (CMS certification number 112847), from CMS Care Compare.

Ellenwood Dialysis Center

Dialysis facility · Ellenwood, GA
3/5 CMS RatingRating period January 2020 to December 2023
OwnershipProfit
CMS Certification Number112847
ESRD NetworkNetwork 6
Hemodialysis Stations16
Medicare-Certified SinceFebruary 2, 2012
Location209 BENNETTE BLVDEllenwood, GA 30294 · Clayton County
Phone(678) 289-0963
Services Offered
In-center hemodialysis

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ellenwood Dialysis Center, LLC's NPI number?

The NPI number for Ellenwood Dialysis Center, LLC is 1235411406. It was assigned to this organization in the NPPES registry on September 14, 2011.

Where is Ellenwood Dialysis Center, LLC located?

Ellenwood Dialysis Center, LLC is located at 209 Bennette Blvd, Ellenwood, GA 30294. The listed phone number is (770) 996-6446.

What is Ellenwood Dialysis Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Ellenwood Dialysis Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2033813) is associated with this NPI, valid through December 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Ellenwood Dialysis Center, LLC a Medicare-certified dialysis facility?

Yes. Ellenwood Dialysis Center is a Medicare-certified dialysis facility, certified since February 2, 2012.

What quality rating does Ellenwood Dialysis Center, LLC have?

CMS rates Ellenwood Dialysis Center 3 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

What insurance does Ellenwood Dialysis Center, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Ellenwood Dialysis Center, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ellenwood Dialysis Center, LLC was last updated on September 14, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.