Organization
TOTAL RENAL CARE INC
Active
Other names
Georgia Dialysis for Adolescents and Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4434 HUGH HOWELL RD, TUCKER, GA 30084-4905
(770) 491-7187
(770) 491-7192
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 928-3545
(833) 214-6980
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD000756
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000619561AD
—
GA
01
—
11D1100178
CLIA
GA
Enumeration date
12/29/2008
Last updated
02/20/2025
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