Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Atlanta South Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
3158 SE MAIN ST, EAST POINT, GA 30344-4800
(404) 761-5593
(404) 761-0622
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7825
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001172
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000879293A
—
GA
Enumeration date
03/15/2006
Last updated
01/24/2014
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