MEDICARE: DVA RENAL HEALTHCARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	ESRD001033	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295703478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DVA RENAL HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4286
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 COLLIER RD NW
Second Line	:	STE B
City	:	ATLANTA
State	:	GA
Zip	:	30309-1710
Country	:	US
Telephone Number	:	404-355-6055
Fax Number	:	404-352-8376

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER
Credential	:
Telephone Number	:	253-733-4500

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/15/2015

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Directions to “DVA RENAL HEALTHCARE, INC ” Practice Location

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