Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
St. Marys Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2714 OSBORNE RD, SAINT MARYS, GA 31558-4049
(912) 882-7507
(912) 882-7523
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
ESRD001079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000410077A
—
GA
05
—
890058200
—
FL
Enumeration date
03/14/2006
Last updated
07/24/2024
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