Organization
PARKER DIALYSIS LLC
Active
Other names
Walton County 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
225 PLAZA DR, MONROE, GA 30655-3184
(770) 207-6942
(770) 267-6811
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD000720
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003131604A
—
GA
01
—
11D2050139
CLIA
GA
Enumeration date
10/30/2012
Last updated
10/18/2024
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