Organization
CARLSBAD DIALYSIS LLC
Active
Other names
South Fulton Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1275 CLEVELAND AVE, 1ST FL, EAST POINT, GA 30344-3433
(404) 305-9080
(404) 305-9084
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003146123A
—
GA
01
—
11D2066342
CLIA WAIVER
GA
Enumeration date
07/29/2013
Last updated
02/18/2025
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