Organization
RENAL TREATMENT CENTERS - MID-ATLANTIC INC
Active
Other names
Panola 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
5360 SNAPFINGER WOODS DR STE 102, DECATUR, GA 30035-4046
(770) 322-1301
(770) 322-2491
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
—
003216012A
—
GA
Enumeration date
04/18/2018
Last updated
08/15/2024
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