TOTAL RENAL CARE INC NPI 1992941736

NPI Information

NPI: 1992941736
Provider Name: TOTAL RENAL CARE INC

Doing Business As: GEORGIA DIALYSIS FOR ADOLESCENTS AND PEDIATRICS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
4434 HUGH HOWELL RD
TUCKER, GA
ZIP 30084
Phone: (770) 491-7187
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TOTAL RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Tucker, GA. TOTAL RENAL CARE INC NPI is 1992941736. The provider is registered as an organization entity type.
The provider Is Doing Business As Georgia Dialysis For Adolescents And Pediatrics.

The provider's business location address is:

4434 HUGH HOWELL RD
TUCKER, GA
ZIP 30084-905
Phone: (770) 491-7187
Fax: (770) 491-7192

The provider's authorized official is Samuel Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 641-6641.

The CLIA number assigned to this NPI record is 11D1100178 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/29/2008 and was last updated on 2/16/2024.

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	ESRD000756	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	000619561AD	MEDICAID	GEORGIA
2	11D1100178	OTHER	GEORGIA	CLIA

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

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