Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Douglasville 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
3899 LONGVIEW DR, DOUGLASVILLE, GA 30135-1373
(770) 949-8403
(770) 949-8406
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
ESRD001038
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000411034A
—
GA
05
—
0112526
—
TN
Enumeration date
03/14/2006
Last updated
09/30/2025
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