Organization
TOTAL RENAL CARE INC
Active
Other names
Cordele 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
1013 E 16TH AVE, CORDELE, GA 31015-1539
(229) 273-0163
(229) 273-5849
Mailing address
5200 VIRGINIA WAY, LICENSURE & CERTIFICATION DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD000777
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
882488002A
—
GA
Enumeration date
05/14/2009
Last updated
11/15/2024
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