Organization
TOTAL RENAL CARE INC
Active
Other names
Tara Boulevard 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
6540 TARA BLVD, STE 200, JONESBORO, GA 30236-1228
(770) 968-8279
(770) 968-8744
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
—
003190972A
—
GA
Enumeration date
12/05/2016
Last updated
09/17/2025
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