MEDICARE: RENAL TREATMENT CENTERS MID ATLANTIC 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

General Provider Information

NPI Number	:	1548830144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL TREATMENT CENTERS MID ATLANTIC INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3240 S COBB DR SE STE 800
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4112
Country	:	US
Telephone Number	:	470-750-0587
Fax Number	:	470-750-0609

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	02/13/2026

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