Upload New Patient DemographicPlease enable JavaScript in your browser to complete this form.Requesting Provider’s Information *FirstLastDoctor's Phone Number *Doctor's Email *Request an NCG Nephrologist by Location *AtlantaFayetteCamp CreekNewnanConyersAny LocationRequest an NCG Atlanta Nephrologist *Dr. BahramiDr. ShoreDr. MudunuruDr. JonesFirst AvailableRequest an NCG Fayette Nephrologist *Dr. ChoDr. ModiDr. MadaniDr. KhanDr. ReddycherlaFirst AvailableRequest an NCG Camp Creek Nephrologist *Dr. BahramiRequest an NCG Newnan Nephrologist *Dr. ChoDr. ModiDr. MadaniDr. KhanDr. ReddycherlaFirst AvailableRequest an NCG Conyers Nephrologist *Dr. DesaiDr. ShoreDr. MudunuruFirst AvailableRequest an NCG Nephrologist *First AvailableUpload Picture of Patient Demographic *How soon does patient need to be seen *4-8 week2-4 week1-2 weekNext AvailableASAPMessage (Optional)Submit
