Organization
TOTAL RENAL CARE INC
Active
Other names
Locust Grove 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
521 STANLEY K. TANGER BLVD, LOCUST GROVE, GA 30248-2591
(770) 914-1432
(770) 957-7565
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
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003155382A
—
GA
01
—
11D2081984
CLIA
GA
Enumeration date
07/31/2014
Last updated
11/11/2025
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