Organization
MOUNTAIN PARK DIALYSIS CENTER, LLC
Active
Other names
Sandy Plains 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
2550 SANDY PLAINS RD STE 160, MARIETTA, GA 30066-7210
(770) 509-1065
(770) 509-9912
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003231664A
—
GA
Enumeration date
05/08/2019
Last updated
09/17/2025
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