Organization
MEDLOCK BRIDGE DIALYSIS LLC
Active
Other names
Mountainside 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
700 N MAIN ST, JASPER, GA 30143-1404
(678) 387-1274
(678) 387-1292
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
Enumeration date
04/07/2020
Last updated
12/29/2025
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