Fayetteville Dialysis

LBN: Dva Renal Healthcare Inc
Fayetteville Dialysis is an health care organization with primary practice located at 1279 Highway 54 W Ste 110 , Fayetteville GA 30214-4551. The organization recently has only one registered license in Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment, which is considered as the primary health care specialty. Dva Renal Healthcare Inc can be contacted via phone (678) 817-9974, or through Wey, Samuel via phone (615) 341-6641.

Contact Information

Primary practice address
1279 Highway 54 W Ste 110 Fayetteville GA 30214-4551
Phone: (678) 817-9974
Fax: (678) 817-9930
Website:
Map and Directions
Authorized official contact:
Name: Wey, Samuel
Phone: (615) 341-6641

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment 261QE0700X ESRD001035 Georgia

Profile Details

NPI number 1679542617
LBN Legal business name Dva Renal Healthcare Inc
DBA Doing business as Fayetteville Dialysis
Authorized official Wey, Samuel
Entity Organization
Organization subpart 1 No
Enumeration date Mar 14th, 2006
Last updated Oct 27th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679542617 NPPES
Georgia Other 11D0952596 CLIA WAIVER
Georgia MEDICAID 000818056A CLIA WAIVER

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