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General NPI Number Information
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NPI Number | 1245520394
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Entity Type | Organization
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Legal Business Name | DVA RENAL HEALTHCARE INC
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 418 DECATUR ST SE SUITE B
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City | ATLANTA
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State | GA
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Zip | 30312-1801
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Country | US
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Telephone | 404-827-0372
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Fax | 404-524-3651
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY 4TH FLOOR - L&C DEPT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone | 615-320-4286
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Fax | 866-594-2893
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER
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Name | JAMES K HILGER
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Credential |
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Telephone | 253-280-9501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | ESRD000729
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License Number State | GA
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