Organization
RENAL TREATMENT CENTERS MID ATLANTIC, INC.
Active
Other names
Southern Crescent Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
275 UPPER RIVERDALE RD SW, STE B, RIVERDALE, GA 30274-2556
(770) 907-7022
(770) 907-7587
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
ESRD000798
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
712860106A
—
GA
Enumeration date
04/26/2006
Last updated
02/11/2026
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