DVA RENAL HEALTHCARE INC NPI 1679542617

NPI Information

NPI: 1679542617
Provider Name: DVA RENAL HEALTHCARE INC

Doing Business As: FAYETTEVILLE DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1279 HIGHWAY 54 W STE 110
FAYETTEVILLE, GA
ZIP 30214
Phone: (678) 817-9974
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DVA RENAL HEALTHCARE INC is an end-stage renal disease (esrd) treatment clinic center in Fayetteville, GA. DVA RENAL HEALTHCARE INC NPI is 1679542617. The provider is registered as an organization entity type.
The provider Is Doing Business As Fayetteville Dialysis.

The provider's business location address is:

1279 HIGHWAY 54 W STE 110
FAYETTEVILLE, GA
ZIP 30214-551
Phone: (678) 817-9974
Fax: (678) 817-9930

The provider's authorized official is Samuel Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The enumeration date for this NPI number is 3/14/2006 and was last updated on 10/27/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD001035	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11D0952596	OTHER	GEORGIA	CLIA WAIVER
2	000818056A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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