Organization
TOTAL RENAL CARE INC
Active
Other names
Mountain Park 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
5235 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3112
(404) 296-1344
(404) 296-4706
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
ESRD000795
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000619561T
—
GA
Enumeration date
10/02/2006
Last updated
06/09/2025
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