Organization
GOLDENDALE DIALYSIS LLC
Active
Other names
Columbus Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1200 BROOKSTONE CENTRE PKWY STE 111, COLUMBUS, GA 31904-2934
(706) 322-2935
(706) 317-4862
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
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134694A
—
GA
Enumeration date
02/07/2013
Last updated
08/02/2024
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