Organization
ISD CANTON LLC
Active
Other names
Northwest Georgia Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
260 HOSPITAL RD, CANTON, GA 30114-2409
(678) 880-3939
(770) 479-9466
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
ESRD001260
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377703973A
—
GA
Enumeration date
06/04/2006
Last updated
08/09/2024
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