Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Hinesville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
522 ELMA G MILES PKWY, HINESVILLE, GA 31313-4021
(912) 368-4850
(912) 368-7247
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
ESRD001148
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000411386A
—
GA
01
—
11D0687785
CLIA WAIVER
GA
Enumeration date
03/14/2006
Last updated
01/12/2021
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