Organization
HAVENWOOD DIALYSIS LLC
Active
Other names
Poplar Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2301 NEWNAN CROSSING BLVD, STE 180, NEWNAN, GA 30265-2576
(770) 253-2403
(770) 253-8092
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003221969A
—
GA
Enumeration date
03/28/2018
Last updated
03/11/2026
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