Organization
DVA RENAL HEALTHCARE INC
Active
Other names
North Fulton 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
1250 N MEADOW PKWY STE 120, ROSWELL, GA 30076-4914
(770) 569-2888
(770) 569-2861
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
ESRD001139
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000696242B
—
GA
01
—
11D0908356
CLIA WAIVER
GA
Enumeration date
03/14/2006
Last updated
08/13/2025
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