Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Thomaston 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
1065 US HIGHWAY 19 N, THOMASTON, GA 30286-2230
(706) 648-6364
(706) 648-3505
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
ESRD001115
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000650372E
—
GA
Enumeration date
03/14/2006
Last updated
04/23/2025
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