Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Laurens County 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
2400 BELLEVUE RD, STE 8, DUBLIN, GA 31021-2856
(478) 272-5190
(478) 275-2433
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
ESRD001149
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000408031A
—
GA
05
—
CT=003123099
—
CT
Enumeration date
03/14/2006
Last updated
06/02/2025
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