Healthcare Provider Details

I. General information

NPI: 1932268240
Provider Name (Legal Business Name): DIALYSIS CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MOUNTAIN VIEW DR
STONE MOUNTAIN GA
30083-3547
US

IV. Provider business mailing address

761 MOUNTAIN VIEW DR
STONE MOUNTAIN GA
30083-3547
US

V. Phone/Fax

Practice location:
  • Phone: 678-516-0030
  • Fax: 770-469-9686
Mailing address:
  • Phone: 678-516-0030
  • Fax: 770-469-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. GWENNETTE JANAYE CLAXTON
Title or Position: OWNER
Credential: RN
Phone: 678-516-0030