Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Wylds Road 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
1815 WYLDS RD, AUGUSTA, GA 30909-4430
(706) 733-0522
(706) 733-0432
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
ESRD001090
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000534388A
—
GA
05
—
125797
—
SC
Enumeration date
03/14/2006
Last updated
09/12/2024
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