Organization
SADDLEBACK DIALYSIS LLC
Active
Other names
Magnolia Oaks Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (SR DIRECTOR LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2377 HWY 196 W, HINESVILLE, GA 31313-8036
(912) 368-2710
(912) 368-2714
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
ESRD000739
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003101245A
—
GA
01
—
11D2003617
CLIA
GA
Enumeration date
09/27/2010
Last updated
09/06/2023
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