MEDICARE: CARLSBAD DIALYSIS LLC

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

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
2	11D2066342	OTHER	GA	CLIA WAIVER

General Provider Information

NPI Number	:	1326480567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLSBAD DIALYSIS LLC

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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 CLEVELAND AVE
Second Line	:	1ST FL
City	:	EAST POINT
State	:	GA
Zip	:	30344-3433
Country	:	US
Telephone Number	:	404-305-9080
Fax Number	:	404-305-9084

Authorized Official
Title or Position	:	VP LICENSURE & CERTIFICATION
Name	:	SAMUEL WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	02/18/2025

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Directions to “CARLSBAD DIALYSIS LLC ” Practice Location

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