Healthcare Provider Details

I. General information

NPI: 1063937241
Provider Name (Legal Business Name): CAHABA DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 LAMAR AVE STE 101
MEMPHIS TN
38114-5614
US

IV. Provider business mailing address

5200 VIRGINIA WAY
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 901-743-9366
  • Fax: 901-743-9369
Mailing address:
  • Phone: 615-320-4514
  • Fax: 866-594-9961

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: JOHN D WINSTEL
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4501