Organization
TOTAL RENAL CARE INC
Active
Other names
Shamrock Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1016 CLAXTON DAIRY RD, STE 1A, DUBLIN, GA 31021-7971
(478) 275-4200
(478) 275-4225
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
ESRD000761
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000619561AC
—
GA
01
—
11D1091873
CLIA CERTIFICATE OF WAIVER
GA
Enumeration date
07/29/2008
Last updated
07/17/2024
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