Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Baxley Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY AO (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
539 FAIR ST, BAXLEY, GA 31513-0112
(912) 366-0202
(912) 366-0333
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
ESRD001055
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000758403C
—
GA
Enumeration date
03/14/2006
Last updated
05/30/2024
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