Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Atlanta West 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
2538 MARTIN LUTHER KING JR DR SW, ATLANTA, GA 30311-1779
(404) 699-1300
(404) 699-1144
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
ESRD001137
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000772549C
—
GA
Enumeration date
03/14/2006
Last updated
01/24/2025
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