Organization
TOTAL RENAL CARE INC
Active
Other names
Victory Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2401 SHELBY ST, COLUMBUS, GA 31903-3360
(706) 682-5327
(706) 682-6059
Mailing address
5200 VIRGINIA WAY, LICENSURE & CERTIFICATION DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD000693
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003142285A
—
GA
01
—
11D2065715
CLIA CERTIFICATE OF WAIVER
GA
Enumeration date
08/12/2014
Last updated
05/22/2024
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