Healthcare Provider Details

I. General information

NPI: 1124081559
Provider Name (Legal Business Name): DCA OF HAWKINSVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 INDUSTRIAL BLVD STE 100
HAWKINSVILLE GA
31036-8002
US

IV. Provider business mailing address

PO BOX 844631
DALLAS TX
75284-4631
US

V. Phone/Fax

Practice location:
  • Phone: 478-892-8008
  • Fax: 478-892-8040
Mailing address:
  • Phone: 870-931-5400
  • Fax: 870-931-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS L WEINBERG
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 214-736-2700