Organization
RENAL TREATMENT CENTERS MID ATLANTIC INC
Active
Other names
Northlake 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
1350 MONTREAL RD STE 200, TUCKER, GA 30084-8144
(678) 406-0825
(678) 406-0830
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
ESRD001189
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000479476M
—
GA
Enumeration date
03/14/2006
Last updated
07/14/2025
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