Organization
DVA RENAL HEALTHCARE INC
Active
Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Fayetteville 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
1279 HIGHWAY 54 W STE 110, FAYETTEVILLE, GA 30214-4551
(678) 817-9974
(678) 817-9930
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
ESRD001035
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000818056A
—
GA
01
—
11D0952596
CLIA WAIVER
GA
Enumeration date
03/14/2006
Last updated
08/04/2026
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