Organization
SUGARLOAF DIALYSIS LLC
Active
Other names
Sugarloaf Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1705 BELLE MEADE CT STE 110, LAWRENCEVILLE, GA 30043-5895
(770) 513-2833
(770) 513-7611
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
ESRD001255
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000973J34K
—
GA
Enumeration date
05/20/2006
Last updated
08/15/2024
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