Organization
LAPHAM DIALYSIS LLC
Active
Other names
Ellijay Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
449 INDUSTRIAL BLVD, STE 245, ELLIJAY, GA 30540-3772
(706) 276-6040
(706) 276-6041
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
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
—
003140980A
—
GA
01
—
11D2068046
CLIA
GA
Enumeration date
07/23/2013
Last updated
11/29/2023
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