Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Southern Lane Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
1840 SOUTHERN LN, DECATUR, GA 30033-4033
(404) 325-8884
(404) 325-8879
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001004
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000622476C
—
GA
Enumeration date
03/14/2006
Last updated
04/01/2020
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