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	ESRD001236	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	:	1558330522
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	:	ATT: L&C DEPT.
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	794 MCDONOUGH RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1572
Country	:	US
Telephone Number	:	770-504-0365
Fax Number	:	770-504-8761

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/16/2025

Similar Medicare Providers

1376575225 — BENNIE R. WHITE JR. MD
Practice Location Address:

794 MCDONOUGH RD , SUITE 105
JACKSON, GA
30233-1572

Practice Phone: 770-775-2341
Practice Fax: 770-775-3668

1033329198 — JACKSON DIALYSIS CENTER
Practice Location Address:

794 MCDONOUGH RD , SUITE 108
JACKSON, GA
30233-1572

Practice Phone: 770-504-9525
Practice Fax:

1306025630 — DR. DERRELL LEVOHN LEGGETT M.D.
Practice Location Address:

794 MCDONOUGH RD , SUITE 108
JACKSON, GA
30233-1572

Practice Phone: 470-251-5300
Practice Fax: 470-251-5301

1306019104 — BENNIE R WHITE JR MD INC
Practice Location Address:

794 MCDONOUGH RD , SUITE 105
JACKSON, GA
30233-1572

Practice Phone: 770-775-2341
Practice Fax: 770-775-3668

1093963944 — SOUTH GEORGIA TREATMENT, INC
Practice Location Address:

794 MCDONOUGH RD
JACKSON, GA
30233-1572

Practice Phone: 770-775-9044
Practice Fax:

1992943195 — DANA B BASS BURCH PA
Practice Location Address:

794 MCDONOUGH RD , SUITE 111
JACKSON, GA
30233-1572

Practice Phone: 470-251-5300
Practice Fax: 470-251-5301

Directions to “RENAL TREATMENT CENTERS MID ATLANTIC INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.