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Dva Renal Healthcare Inc
End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fayetteville, Georgia
NPI 1679542617

Dva Renal Healthcare Inc is a End-Stage Renal Disease (ESRD) Treatment Clinic/Center based in Brentwood, GA and is specialized in End-Stage Renal Disease (ESRD) Treatment. Dva Renal Healthcare Inc practices in Fayetteville, GA. The NPI Number for Dva Renal Healthcare Inc is 1679542617 and holds a License No. ESRD001035 (Georgia).

The current practice location address for Dva Renal Healthcare Inc is 1279 Highway 54 W Ste 110, Fayetteville, GA and can be reached out via phone at 678-817-9974 and via fax at 678-817-9930.

Location: 1279 Highway 54 W Ste 110, Fayetteville, GA, 37027-7569
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1679542617
Provider Name
Dva Renal Healthcare Inc
Credential
Provider Entity Type
Organization
Address
1279 Highway 54 W Ste 110, Fayetteville, GA, 37027-7569
Phone Number
678-817-9974
Fax Number
678-817-9930
Provider Enumeration Date
03/14/2006
Last Update Date
09/14/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
11D0952596 01 GA CLIA WAIVER
000818056A 05 GA
institution
Provider Business Practice Location Address Details
Address
1279 Highway 54 W Ste 110
City
Fayetteville
State
Georgia
Zip
30214-4551
Phone Number
678-817-9974
Fax Number
678-817-9930
person
Provider Business Mailing Address Details
Address
1279 Highway 54 W Ste 110
City
Fayetteville
State
Georgia
Zip
30214-4551
Phone Number
678-817-9974
Fax Number
678-817-9930
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
End-Stage Renal Disease (ESRD) Treatment
Taxonomy
261QE0700X
License No.
ESRD001035 (Georgia)
Definition
Definition to come...
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